Northeast Florida Medicine - A Special Festschrift to Honor Dr. Thomas Chiu by Duval County Medical Society

A Festschrift in Honor of Thomas Chiu, MD EDITOR IN CHIEF Raed Assar, MD (Chair) MANAGING EDITOR Laura Townsend ASSOCIATE EDITORS Sunil Joshi, MD (Vice Chair) Kim Barbel-Johnson, MD Mark Fleisher, MD Ruple Galani, MD James Joyce, MD Daniel Kantor, MD Joseph Sabato, Jr., MD James St. George, MD

EXECUTIVE DIRECTOR Bryan Campbell DCMS FOUNDATION BOARD OF DIRECTORS President: Todd Sack, MD President-elect: Guy Benrubi, MD Secretary: Allen Seals, MD Treasurer: Malcom Foster, MD At Large Seat 1: Ruple Galani, MD At Large Seat 2: Eli Lerner, MD

Northeast Florida Medicine is published by the DCMS Foundation, Jacksonville, Florida, in partnership with the County Medical Societies of Duval, Clay, Nassau, Putnam, and St. Johns. Except for official announcements from the County Medical Societies, no material or advertisements published in NEFM are to be seen as representing the policy or views of the DCMS Foundation or its colleague Medical Societies. All advertising is subject to acceptance by the Editor in Chief. Address correspondence and advertising to: 1301 Riverplace Blvd. Suite 1638, Jacksonville, FL 32207 (904-355-6561), or email: ltownsend@dcmsonline.org.

Festschrift 2014

Contents

Tom Chiu, MD: The Jacksonville Pediatrician

By Mobeen H. Rathore, MD, CPE, FAAP, FIDSA, FSHEA, FACPE, FPIDS

Reflections on my Father By Charmaine Chiu

Tom Chiu â&#x20AC;&#x201C; A Constellation of Achievement

By Gerold L. Schiebler, MD

From Sun Tzu to Colin Powell By Jeffrey Goldhagen, MD

September 12, 2014 Mr. Thomas Chiu, MD University of Florida College of Medicine Post Office Box 100215 Gainesville, Florida 32610 Dear Dr. Chiu: It is my privilege to congratulate you on your recognition by the Duval County Medical Society and Foundation in the upcoming special edition of the Northeast Florida Medicine Journal. I understand that you have cultivated a distinguished career as a pediatrician in the greater Jacksonville area for over 40 years, and are an integral part of the Jacksonville medical community. You are to be commended for assisting in the development of a citywide neonatal program and for the significant role you played in helping to decrease our neonatal mortality rate. As chairman for the Department of Pediatrics at the University of Florida’s College of Medicine, you are responsible for developing and expanding many programs, including championing the relationship between the university and Wolfson Children’s Hospital and Nemours Children’s Clinic. The admiration of your colleagues and patients is evident and your accolades are too numerous to list. On behalf of Jacksonville, please allow me to express my heartfelt appreciation for the incredible way you continue to positively impact not only our community, but also Florida’s First Coast. Sincerely,

Alvin Brown Mayor

St. James Building | 117 West Duval Street, Suite 400 | Jacksonville, FL 32202 PH: (904) 630-1776 | FAX: (904) 630-2391 | www.coj.net

Tom Chiu, MD: The Jacksonville Pediatrician By Mobeen H. Rathore, MD, CPE, FAAP, FIDSA, FSHEA, FACPE, FPIDS Director, University of Florida Center of HIV/AIDS Research, Education and Service (UF CARES)

first met Dr. Thomas Chiu when I visited Jacksonville in 1990. Frankly he did not leave much of an impression with me. He was sitting in a small office that appeared to have been overrun with papers. He asked me a few very specific questions and answered my questions briefly, but thoughtfully. However, when I left the meeting with him I felt good about my visit with him and that was it. He did introduce me to this woman who apparently worked for him saying she is the most important person in his division and makes everything happen and gave her all the credit. I made nothing of that statement. When I sat down to write this piece I recalled that first visit and it really summed up who Tom Chiu is: a quiet, thoughtful, and modest man who is always ready to give credit to someone else. A wise man

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once told me that you can accomplish a lot if you don’t worry about who gets the credit and that is how Tom operates. He focuses on a goal and gets everyone engaged. He takes their opinions seriously and usually comes up with a simple, yet effective plan. Over the years I have seen Tom value everyone for their individual strengths, even if he didn’t agree with someone. He kept his doubts to himself and always had a positive spin on anything that happened. He loves to say that when one door closes another one opens. I thought of all of Tom’s accomplishments, and they are numerous. Tom has been in Jacksonville for 40 years and his talents were recognized early. Always being foresighted, he realized that medicine is going to become a business so he went back to school to get his MBA. This was when very few physicians were getting involved in the business

of medicine let alone getting a degree in business. Below are two comments from past Chairs of the Department of Pediatrics in Jacksonville who realized early that Tom is a gem. The late, Dr. Sidney Levin the first Chairman, Department of Pediatrics said the following about Dr. Chiu: “I recruited him after his fellowship under Dr. Mary Ellen Avery in Boston. He always made me very proud. He related very well to hospital administrators. He was a builder; put things together and made it happen. When I was critically ill from my heart operation, he was at my bedside every day. I never heard anyone say anything bad about Dr. Chiu.” Dr. Robert Miller, one of the past Chairmen of the Department of Pediatrics, described Tom best: “Sitting in faculty meetings Dr. Chiu would explain his vision and I would think he is either on something or totally naïve. He is gentle and patient and he got his point across. He built this department through resources from the community and state. I think the President of the United States should send him to Iraq and he can settle half the problems without much difficulty. He not only gets it right at home, but he gets it right at work, too.” I started thinking off all the things he has done since he has been in

Jacksonville. I thought I could write about his vision in developing the city-wide neonatal program, and decreasing the neonatal mortality rate in Jacksonville. Tom established the citywide neonatal program before I got to Jacksonville. Although the program is no longer a citywide program, however, the fact that the neonatal services in the city of Jacksonville remain strong is because of Dr. Chiu. Even though he has not been at the helm of the neonatal program for almost 20 years, it was his efforts that brought neonatal programs in St. Augustine and Daytona Beach under the banner of department of pediatrics. Certainly the neonatal program in Jacksonville is a feather in Tom’s cap that could only be possible because of his vision and foresight. For most academics that one achievement would have been enough of an accomplishment. Dr. Richard Bucciarelli, Past Chairman, Department of Pediatrics in Gainesville who has known Tom for 33 years offered his admiration: “Dr. Chiu’s greatest achievement is the citywide Neonatal Program he started in Jacksonville. It served as a national model program for many cities. He is very devoted to his patients, students and family. He is a unique individual, brilliant, a wonderful doctor and a very caring person. He genuinely cares for everyone.” However, Tom was not done yet. He wanted to even more for children and to improve the healthcare of children on the first coast. His

A Festschrift in Honor of Thomas Chiu, MD

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Four generations of pediatricians touched by Dr. Chiu.

drive to improve the lives of children and families is best summed up by Dr. Elisa Zenni: “It is difficult to adequately describe the far-reaching and enduring impact that Dr. Chiu has had on the Pediatric community of Jacksonville. He is a visionary and innovative leader who deeply cares about children and families, and is an inspiration to all who come in contact with him. As chairman, he treated every member of the department like family and encouraged us to work together toward common goals, always in the best interest of children. It’s been an honor and privilege to be a part of the Department of Pediatrics at the University of Florida College of Medicine – Jacksonville under his leadership.”

When Tom became the Chairman of the department, it was a broken and demoralized department. The Department had few allies and its programs were faltering. Several years prior to when he became Chairman in 1996, many of the faculty had left and programs significantly weakened. However, the eternal optimist, Tom only looked at the glass as half full and focused on the department’s strengths, which included the strongest element, a committed and hardworking remaining faculty. He raised the faculty morale in a way that only Tom can do. He is phenomenal in developing strong relationships. Dr. Anne Usitalo is equally praiseworthy of Tom as she recounted: “I’ll remember Dr. Chiu for the depth of his commitment to the children of Jacksonville and to his staff, both professionally and personally. He encouraged me to seek opportunities for professional development, and supported every effort I made to enhance my ability to care for patients. Most of all, he was a genuinely kind and caring individual, always ready with a smile, words of encouragement, and a sincere interest in how I was doing. I’m very grateful I had the opportunity to know and work with him.” Tom took on the monumental task of rebuilding the department in all three of its co-equal missions of education, clinical service and research. In this effort, Tom acted less of the Captain of the ship, but more a leader of the team.

A Festschrift in Honor of Thomas Chiu, MD

With a strong core of 25 faculty members Dr. Chiu embarked on the first task of developing relationships with his faculty and those outside of the department who were important in the re-building process. He had to balance competing interests of several institutions and the mother ship in Gainesville. The department in Gainesville had never been better than when Tom was the Chair. He brought the two departments close, and it is fair to say the departments of pediatrics in Jacksonville and Gainesville had the best relationship among all of the departments on the two campuses. Tom also found an able and willing ally and partner in Dr. Larry Freeman of Wolfson Children’s Hospital. He further improved the existing relationship with Wolfson on pragmatic business models that were “win-win” for Wolfson Children’s Hospital and UF Health, but most importantly for the children of northeast Florida and southeast Georgia. He developed several programs in collaboration with Wolfson Children’s Hospital including an excellent pediatric critical care program. Chief of Pediatric Critical Care, Dr. Michael Gayle, one of the people recruited by Dr. Chiu, had this to say, “I met Dr. Tom Chiu when I was recruited to the Department of Pediatrics in 1992. I have had the pleasure of working with him as my Chairman for more than 20 years. I would describe Dr. Chiu as the

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“Text book” role model for a pediatrician. His dedication, concern and desire to improve the health and well-being of all children, both inside and outside of our community, has been exemplary. Dr. Chiu has been a tremendous inspiration to me as a faculty member and we have been very fortunate to have him in our pediatric community.” Tom learned early in his career that medicine is as much a business as it is a mission. Although he had a strong faith in what he was doing he kept it on sound fiscal and business footing. On countless occasions when I went to Tom to ask him if I could do this or develop that his response was often something to the effect, “If it is the right thing to do and you think you can pay for it, go for it.” That sums up how Tom operates. He has faith in you, encourages you and helps you to get where you want to go. He is entrepreneurial and willing to take calculated risks. I believe I was not the only one to whom he responded in this fashion. Tom was always in the background looking over what we did, but he was never in the way. One of Tom’s geniuses was the strategy of getting ahead of the fiscal ebbs and flows. He did this by focusing on the department getting as many grants and contracts as possible so that we did not have to count solely on clinical revenue. That is what allowed us to build and increase our faculty from 25 to as many as 114 faculty members

at one point, and thereby becoming the largest department on the campus. He focused on all possible sources State and Federal contracts and grants, foundation funding, funding for research, be it from the National Institutes of Health or pharmaceutical industry. His department received the first NIH grant on the University of Florida’s Jacksonville campus, and at one time the department had almost 75 percent of all research funding on the Jacksonville campus. But Tom was not only about finances as he continued to support the development of additional programs for children of northeast Florida. The pediatric cardiovascular program that he established in strong collaboration with Wolfson Children’s Hospital is in no small part because of Tom’s efforts and his vision. The primary care program that Tom developed in collaboration with the Duval County Health Department remains a national model to this day on how academic and public health can collaborate to serve children. The expansion of the pediatric forensic program in Jacksonville was also due to strong efforts and sound planning done by Dr. Chiu. But he did this by identifying talent and getting it to Jacksonville. It was the recruitment of Randy Alexander, a recognized global authority in forensic pediatrics that made the forensic pediatric program what it is today. It was the recruitment of Dr. Jeff Goldhagen, the most

energetic and forward thinking general pediatrician that I know, that allowed for the development of the primary care program with Duval County Health Department. It was the recruitment of the exceptional cardiologist like Dr. Jose Ettedugi that resulted in making the pediatric cardiovascular program in northeast Florida what it is today. But it is even more than that. Tom saw the need to have a transition program for the adolescent, and recognized the ability and passion of Dr. David Wood in wanting to do this. Tom supported and encouraged him to establish that program which is a model that is being replicated in the rest of Florida. Tom looked at what was needed in the future and started the pediatric physical medicine and rehabilitation program as well as the complex child program, both of which are much needed in our community and rarely available in most communities around the country. Tom saw the need of mental health and developmental program, and once again recruited the hardest working developmental specialist in the form of Dr. David Childers, Jr. Tom always looks for the best person for a job and recruits them aggressively and retains them effectively. Mary Lim had to say this about Dr. Chiu: “Dr. Chiu is responsible for my presence at UF for the more than 20 years. I do believe in his vision of making a better place for children

A Festschrift in Honor of Thomas Chiu, MD

“The one remarkable attribute of Dr. Chiu, that distinguishes him from many accomplished leaders in the medical field, is his capability to harness diverse resources in the community thereby uniting different institutions for the common goal of improving health care of all children in the community.”

in the community; his dedication to academic excellent. He is a good representative for UF for which he dedicated his time and energy. He has built the department to where we are now. The University & the community owe him a debt of gratitude and we must acknowledge all his accomplishment. I can sincerely claim that he is my mentor and good friend.” Another of our exceptional neonatologist Dr. Renu Sharma commented: “I consider myself privileged to work under the tutelage of Dr. Chiu for nearly 30 years; he served as my teacher during my pediatric residency at UF (then known as the University Hospital), subsequently as my mentor when he was Chief of my Division and the Chairman of my Department. I learned many valuable lessons from him – especially

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those that are not written in the medical books. As a faculty member, I have watched his governing style driven solely by his passion to improve healthcare delivery to children in the entire community of Northeast Florida. The one remarkable attribute of Dr. Chiu, that distinguishes him from many accomplished leaders in the medical field, is his capability to harness diverse resources in the community thereby uniting different institutions for the common goal of improving health care of all children in the community. As an emissary of children, he fostered solidarity by negotiating obdurate situations enabling others to envision the long term benefits of working together. As a result of such various partnerships, children in our community have access to a comprehensive array of pediatric subspecialists. Aside from the community, under his leadership

within UF, the Department of Pediatrics grew to become the largest department in the College of Medicine at Jacksonville. His governing approach integrated teaching, research and clinical care in a manner that all three facets grew equally. Dr. Chiu’s tireless efforts contributed significantly to the growth of the Pediatric community. Furthermore, I am indebted for my personal growth as I learned many valuable lessons from Dr. Chiu.” The pediatric educational program under his leadership also excelled. We are not only recruiting the highest caliber residents, but also as a consequence of the many initiatives and achievements that Tom put in place our residents are finding fellowships in the most prestigious programs and those who want to go into primary care are highly sought out by local practices. He put together a team led by Drs. Jose Zayas and Ayesha Mirza that has borne tremendous fruit, and this past year 100 percent of our graduating residents passed their pediatric board examination in first attempt. Dr. Zayas who is the residency program director offers his praise for Tom, “Tom has been a great mentor in the area that matters the most… people. Working with, learning from, collaborating with, leading,

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and caring for. I learned to always start off and end on a positive note…people remember the circumstances surrounding when they start a new job and when they move on the most. I watched him attend (and quietly exit) anything he was invited to. He knew the impact that gesture of respect had on building relationships. I learned that leading has far more to do with relationships than anything else and to always give everyone the benefit of the doubt. I learned to be comfortable in “crisis” and look for the opportunity. I know he likes ice tea (not coffee) and apple pie. I know that he is a devoted husband, a loving father and a doting grandfather. He is genuinely kind to his staff. He loves the gators. He has been, and continues to be, a GIANT in advocating for healthcare system improvement in our city and state. He has coached many of our residents on how to score a great job and given the tips on the economics of medicine and personal fiscal responsibility. It seems to me he lives by this Chinese proverb: “If you want one year of prosperity, grow grain. If you want ten years of prosperity, grow trees. If you want one hundred years of prosperity, grow people.” He has cultivated and grown many people. I am lucky to be counted

“Dr. Chiu has been vital to our medical education and growth as pediatricians. He has always been approachable for advice and guidance.”

among them.” Tom always cared for our trainees. Not only did Tom want them to get the best education, but he also cared for their wellbeing. The resident call of 2014 that just graduated had this to say, “Dr. Chiu has been vital to our medical education and growth as pediatricians. He has always been approachable for advice and guidance. He was the first attending who knew our first and last name within the initial 24 hours of entering residency! He orchestrated a medical economics course for third year residents on his own accord, in which representatives from the community and key financial institutions within the university offered invaluable advice and guidance. Dr. Chui has always been a true advocate for residents and an outstanding role model as we venture out into our careers.”

Tom had a goal to have more pediatric fellowship programs. He encouraged and supported the starting of pediatric infectious diseases fellowship program and subsequently started the work on the four additional accredited fellowship programs in Jacksonville, including endocrinology, Forensic pediatrics, hematology/oncology and palliative care. Tom extended the reach of the department all the way to Hong Kong and all of China with trainee and faculty exchanges and educational conferences. Dr. Bill Chan of Hong Kong was a collaborator with the department on many of these efforts and had this to say: “Tom opened a window for the medical professionals in Hong Kong, so that they could access to the world. Before the early 90s, all of our postgraduate medical training was in the United Kingdom. Tom

A Festschrift in Honor of Thomas Chiu, MD

helped us to send various colleagues to Florida to see how pediatrics was practiced in the United States. This year, we start to have clinical pharmacists joining our rounds in all pediatric wards throughout Hong Kong. This would not have happened if Tom did not help our first pediatric clinical pharmacists to visit Jacksonville. Without Tom, our clinical psychologists, pediatric nurses and community pediatrician would not have the opportunity to see how child protection could be improved in our practices. I have lost count of the number of neonatologists visiting the modern NICUs in Jacksonville. They have made our neonatal service comparable to that in the contemporary world. Many of our pediatric infection specialists gained a great deal of insights after their intellectual exchanges with their counter-parts in the University of Florida. Tom also introduced us to many friends from your part of the world – all experts and enthusiasts in their own right in child health. We are celebrating the 25th the Florida-Hong Kong connection next year. All these would have never happened, without the foresight, passion and leadership of Tom.” Anything you see in the University of Florida department of pediatrics you can be sure Tom Chiu had a hand in it. The current administrator of department of pediatrics, Melissa Scites,

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who has been with UF CARES for 16 years until she became the department administrator, realized very quickly Tom’s large footprint on department of pediatrics: “A truly remarkable visionary, leader, and compassionate pediatrician. Dr. Chiu’s extraordinary contributions to the UF Department of Pediatrics and to children and families throughout the state of Florida are immeasurable. He is an inspiration to us all and he will be revered for generations to come.” By the way, the woman Tom introduced to me during my interview, who became one of my best friends over the past 23 years, was Sandy Barata, past Administrative Director, Department of Pediatrics. Sandy was always on Tom’s side and played a major role in the department growth and faculty morale. Given all the praise of Tom’s accomplishments by his colleagues, peers, and coworkers, I find it fitting to conclude this article with one more form Ms. Barata: “I have known Dr. Chiu for more than 20 years. The Department of Pediatrics doubled from six divisions to 15 divisions under his leadership. The faculty size tripled in numbers. He’s a visionary and sees five or 10 years ahead for children’s health care needs. Dr. Chiu has a great sense of humor although a lot may not know this. He’s very proud of his faculty and the things they accomplished.” v

Reflections on my Father By Charmaine Chiu

uch of this edition of Northeast Florida Medicine has been dedicated to my father’s professional accomplishments. I was approached by the publication with the specific task of providing perspective on my father as family man: the formative moments of his youth; the private thoughts that occupy the space in between patients, meetings, and other professional obligations; the personal joys that have rounded out his work achievements. It’s a daunting task, really, if you think about it, capturing in thirty five hundred words or less the essence of a man of monumental importance in your life. Until there is a moment of relative clarity and I realize that my task is actually quite simple.

That moment of relative clarity came when – being not a particularly religious person, but struck with an occasional and random need to refer to words carrying spiritual weight – I turned one day to Khalil Gibran’s The Prophet. On the subject of work, Gibran writes: And what is it to work with love? It is to weave the cloth with threads drawn from your heart, even as if your beloved were to wear that cloth. It is to build a house with affection, even as if your beloved were to dwell in that house. It is to sow seeds with tenderness and reap the harvest with joy, even as if your beloved were to eat the fruit.

I know my father as all of you know my father.

A Festschrift in Honor of Thomas Chiu, MD

Dad led the University of Florida’s Department of Pediatrics in Jacksonville by ‘building a house with affection’ in the same manner that he built his own house with affection. You have known the same sort of love that all of us in the family have known. Your love has come in the form of hands guiding you as you intubated your first neonate, balanced departmental budgets, constructive comments on professional résumés, patiently mediated disagreements amongst colleagues, and the careful diplomacy required to grow the Department such that its influence now extends far beyond the bounds of Duval County. Our love has come in the form of beaming smiles at piano recitals, reassuring hugs, doughnuts and freshly squeezed orange juice on Saturday mornings, reminders to gas up the car and periodically rotate its tires, and college tuition. Love that is different in form, but the same in substance, magnitude, and intensity. To understand how Dad came to approach work and family with such equal devotion, one must first understand his upbringing. It sounds horribly pedestrian to say that my paternal grandfather was the single most important influence in Dad’s life, but such is the truth. A gentle faced soul with smiling eyes that belied his incredible determination, my grandfather carved out a comfortable life filled with simple joys for his family. He supported my grandmother, four sons, and a daughter by operating a small general store, located on a narrow side street in the Happy Valley district of Hong Kong. One

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half of the store was a traditional Chinese apothecary, with its floorto-ceiling wall of wooden drawers and giant glass jars packed with all manners of desiccated peculiarities, smelling simultaneously of camphor, ginseng, and hints of briny ocean. The other half of the store featured loaves of white bread, Coca-Cola® in its iconic green glass bottles, stacks of Cadbury® chocolate bars, and other Western niceties. Dad and his siblings hiked up and down the steep hills of Happy Valley to deliver milk and other staples from the store to their neighbors, when they were not in school. There were weekend swims in the harbor to build muscles and clear minds. There were large family dinners; these were always preceded by a few competitive rounds of mah jong amongst all of the uncles and aunties, and the cacophony of little green and white tiles clacking against each other. There were big red tubs of Dairy Farm® ice cream happily split amongst all in the swampy, subtropical heat of the summer months. It was an idyllic childhood in what some might consider the golden age of a great city. But the fact of the matter is that things were not always as simple as they seemed. My grandfather found himself placed in the impossible position as a very young man of having to care for himself and his siblings. He was scrappy. He took whatever odd jobs there were

Thomas Chiu, MD, as a young boy.

to be found. It was a time during which children’s social services of the sort that are established today were few or non-existent. But my grandfather searched, negotiated, and worked his way into the hearts of a family in Cheung Chau – an outlying island southwest of Hong Kong – that eventually took him and all of his siblings in as their own. It was an act of grace that was never forgotten. My grandfather always felt fiercely indebted and loyal to this family who might not have given him birth, but did give him a chance. Constancy of this nature must permeate one’s soul, because my grandfather remained unwaveringly and unconditionally true to all those who he loved throughout his life, the sort of man who would loan his last dollar to a friend even if it mean that he would himself suffer without. Qualis pater, talis filius. Growing up, Dad must have quietly observed and absorbed the sort of steadfastness that my grandfather practiced. He packed it up neatly in his suitcase and carried it with him across the seas in the early 1970s upon starting his pediatric residency here in Jacksonville, at what was then University Medical Center. Over the years, Dad has had a number of offices on the hospital campus: a humble, closet-sized space with two windows that overlooked the third floor normal newborn nursery; a converted patient examination space with Brady Bunch-esque faux wood paneling, the track for the privacy curtain still installed in the ceiling; a ‘corner office’ space

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within the Learning Resource Center. But his professional home has always been within those buildings on West Eighth Street, in the once modest white façade facility that has now become an academic medical powerhouse. In current times, when loyalties change seemingly as often as the winds, Dad has always remained true to the institution – and the people – who offered him his first professional opportunity. In December 1972, not long after his arrival here in the United States, Dad married the love of his life. Mom was a vivacious coed with movie star looks, a wardrobe full of bespoke lace shift dresses, mean dance moves, and an aptitude for science that rivaled that of her most brilliant male classmates at the University of Hong Kong. She had no shortage of suitors in college, and in those Mad Men-esque days could have easily slipped quietly and comfortably into the role of a lady who lunched. As enticing as that lifestyle might have been, however, Mom has always had the faintest streak of iconoclast in her character. She craved the complex Cantonese dishes served during multicourse banquets typical of business dinners in Hong Kong, but dreaded evening upon evening of tedious mealtime small talk that seemed de rigueur in those circles. She had a keen eye for Dr. and Mrs. Chiu wedding banquet in Hong Kong, December 1972, with Mrs. Chiu’s parents.

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all things sartorial, but loathed the practice of wearing brands as a sort of competition amongst society wives. She deeply respected Chinese tradition, but found rather despicable the inordinate pressure placed upon women to bear sons for the purpose of carrying on the family name. It was actually Mom who might have first suggested moving to the United States after getting married. Such is her strength, to be willing to part from all that she had ever known for the opportunity to build a life in an environment completely unknown. Dad would heartily agree that for all of his public accolades and achievements, Mom has been a private and unsung heroine. She whittled down her worldly possessions to fit into two aqua colored, hard bodied suitcases. She walked in the dark from their modest apartment along River Road towards Baptist Medical Center every morning in those initial years, having parlayed her science degree into a job at the hospital’s clinical laboratory in order to help pay the bills. She quickly learned to expertly navigate the kitchen, even though she had never so much as pressed the start button on a rice cooker prior to her arrival in Jacksonville. She scrimped, saved, and managed the household budget with an eagle eye, carefully balancing her check book daily in her trademark meticulous cursive. She became an engineer in her own right – learning the inner workings of air conditioning systems, plumbing, and major

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household appliances – determined never to be duped by repairmen. She dutifully waited in school pickup lines, at orthodontists’ offices, on a bench outside of our piano instructor’s studio, and countless other places, ever present for both me and my sister. This was love in practice. Not the syrupy, romanticized variety of love, but the sort that plays itself out in small, repetitive ways throughout the daily rhythms of family life. It was a love that allowed Dad the freedom to pursue all that he has accomplished professionally throughout his career. And although the love between spouses should never be transactional, nor have my parents ever treated it as such, Dad has never forgotten or taken for granted the sacrifices and efforts on Mom’s part. The Reverend Theodore M. Hesburgh, an American Catholic theologian and former President of the University of Notre Dame, once remarked that the most important thing that a father can do for his children is to love their mother. Dad has done this a million times over. His love has also been expressed in small, repetitive ways: making sure that Mom is never alone at any physician appointments; driving her to Saturday morning ‘coffee club’ with the gaggle of Chinese women that have kept her moored since her arrival here in the United States; always offering to bring home take out for dinner, with a grateful reminder that she has cooked enough meals over these many years.

It is impossible to grow up in such an environment and not have a healthy amount of respect for Mom and Dad. For me and my sister, those small, repetitive gestures that Mom and Dad exchanged were like the individual dots of color in a pointillistic painting; relatively insignificant when viewed on their own, but ripe with significance when viewed collectively and from a distance. And once the whole painting is fully appreciated, the individual dots can never be looked upon as mere individual dots again. Now that my sister and I reflect upon our childhood – now that we are both grown women, professionals, and parents, and have had the benefit of both time and maturity to see things in an entirely different perspective – the meaning of all of those small, repetitive gestures comes into view. A parent performs many gestures on behalf of a child, of course. But one in particular has seared itself into my memory, when it comes to Dad. It is the sort of gesture that – were I an actress and a script required me to cry Oscar-worthy performance tears (which thankfully my relatively asceptic, serious, and rule-driven practice of law never requires) – would be the deep-seated memory to which I would turn to get the job done. This is one of my most treasured ‘individual dots’. Few days compare in my life to the day that I moved in to Harvard Yard in 1992, at the start of my freshman year in college. There is

nothing more magical than early fall in Harvard Yard: the soft grass has been well groomed by the landscaping crews to welcome new students and their families; the sunlight filters through magnificent oaks, their tops just beginning to burnish with the gold and orange hues of the season; the zigzagged pathways teem with students, small groups each seemingly speaking languages from different corners of the world, their conversations punctuated only by the occasional ringing of the Memorial Church bell. As I collected my dorm room keys from the housing office representative from the white tent that had been set up in the middle of Harvard Yard, I was bursting with nervous anticipation and excitement. This was before the days when smart phones were a compulsory fashion accessory. Calls home were still made from the single land line in the dorm room, which was equipped with an extra long cord so that the phone could be toted into the closet and the door closed if privacy was needed. There were no iPads or iMacs or iAnythings. Messages to friends were scrawled on small white marker boards hung outside our dorm rooms, not texted. I distinctly recall opening the Harvard University phone book and seeing that some, not all, faculty and staff had these odd designations underneath their office addresses and phone numbers ending in ‘@harvard.edu’ and thinking, “What sort of odd Yankee university phone system is this?”

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Dr. Thomas Chiu with his daughter, Charmaine, on her birthday in May 1977.

For context, I had completed many of my high school essays either by hand or on an ancient Olivetti manual typewriter. At some point towards the end of my high school career, Dad actually purchased an Apple IIe, a gargantuan machine whose word processing function had me staring at a dark screen with eye-crossing green lettering for hours on end. The Apple IIe did not make it on the trip to Cambridge; my sister needed it at home so that she could complete her high school assignments. Dad excused himself at some point from the move in festivities in my fourth floor room at Thayer Hall that day. He walked clear across campus to the university’s technology office to purchase a new computer for my college studies, although I was not aware of his intention to do so at the time. Anybody who knows Dad can tell you that he’s not built to win Olympic gold medals; his good heart

is housed in quite an average body, which he has always cared for but never sought to build beyond what was naturally given. But there was my sweet father, the next time we saw him: his arms wrapped around an awkwardly large, square box half his height; his upper torso angled uncomfortably backwards in order to support the weight of the contents; cautiously steering himself along the crisscrossed pathways back towards Thayer Hall, completely unable to see his feet. He was doing all of the things that his own doctors likely warned him against, given that he was no longer a young man. He was doing it anyway, because it needed to be done. I think that this is the reason people are always so complimentary of Dad, when I first meet them and we discover that we have him in common. For him, it is not about ego. It is not about competition. It is not about accumulating honors and awards. It is about casting all of those things aside, rolling up one’s sleeves, and doing what needs to be done for the community that he serves and the family that he adores. It is all about love. v

A Festschrift in Honor of Thomas Chiu, MD

Tom Chiu – A Constellation of Achievement By Gerold L. Schiebler, MD

Distinguished Service Professor Emeritus, Department of Pediatrics, University of Florida College of Medicine

t is my special opportunity, and indeed privilege, to write an article about THOMAS T. CHIU, M.D., M.B.A., whom I have known for over four decades.

I shall employ the following format- utilizing his initials to outline his constellation of attributes and achievements.

T: Tenacity—coupled with unusual patience, was, and remains, one of his prime characteristics. He, throughout his academic career, was inordinately adept in recognizing that eventual success can be achieved with many small steps toward the desired goal. H: Health Information Endeavors—remain a prime component of his cohort of activities. At the national level, he was a lead author of the position paper on “Medicaid” adopted as a nationwide policy by the American Academy of Pediatrics (AAP).

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Furthermore, for more than a decade, he was Chair of the Financial Management Workgroup- an advisory body on all financial topics to the leadership and staff of the Division of Children’s Medical Services (CMS) in the Department of Health. O: One of the earliest pioneers in Florida in the rapidly developing pediatric subspecialty of neonatology—having taken a component of his early training at the University of Florida/ Shands Hospital in Gainesville. M: Management Style—This was a format by which he engendered trust and loyalty with all individuals with whom he had contact. He took great pride, and received much satisfaction in having his colleagues on the faculty do well. One of his outstanding management traits was to delegate responsibility in a very effective fashion – both to

his professional colleagues and to his administrative staff. A: Accomplishments were many—One of his initial achievements was the innovative development of a Jacksonville city-wide neonatology service, linking together operationally all neonatal intensive care units (NICU’s). This outstanding arrangement was later fractured by “outside forces”– a change devoid of any component of “quality performance.” S: Statewide Issues are a continuing component of his professional endeavors—relating to many facets of overall child health care. For many years he has been a local and regional leader – initially as Medical Director of the Jacksonville area for Children’s Medical Services (CMS), and later becoming Regional Medical Director for Northeast Central Florida – encompassing 23 counties. T: Telemedicine, a new initiative fostered by him—an effort of expanding this system of transmitting health care information throughout the northern and central portions of the state. This endeavor in being designed to enhance the delivery of health care services to children, both primary and sub-specialty care, in a more efficient and cost effective manner. Thomas Chiu, MD, with his parents, on graduation day from the University of Hong Kong in 1970.

C: Chairman of the Department of Pediatrics–University of Florida College of Medicine Jacksonville for over two decades—This is a very long tenure as the chair of an academic department in a College of Medicine.

A Festschrift in Honor of Thomas Chiu, MD

This was the largest, most stable department on the Jacksonville campus. Indeed, during his period as Chair, he fostered the career leadership development of three Associate/Assistant Deans – Elisa Zenni, Mark Hudak and Frank Genuardi. H: Home environment was an outstanding model—It is an example of longevity, love, and a tremendous relationship with his wife, Anna, who was the fulcrum in any family decision. This outstanding cadre of relationships included their two high achieving daughters: Charmaine, a prominent lawyer in Jacksonville, and Christine, an established family medicine physician in Tallahassee. This family unit has been enhanced by four grandsons, each of which has their own special set of talents and traits. I: Intrinsic elegance—This component of his overall operational gestalt manifested itself by his being a superb recruiter of outstanding faculty and staff. One component of his outstanding success as a Chair was that the faculty he recruited garnered more than 70 percent of all research monies and grant funds on the entire Jacksonville campus. U: Understanding how to be effective in a very complex and demanding administrative and educational environment—In his time as Chair, he had to deal on a continuing basis with the following

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administrative entities: University of Florida- Jacksonville, University of Florida–Gainesville, the U/F Health center–Jacksonville, the U/F– Shands Health Center in Gainesville, Wolfson Children’s Hospital, Nemours Children’s Clinic in Jacksonville and the private practice community pediatricians in Jacksonville. This formidable task he continually addressed with unusual insight, tact, and understanding of the priorities of each involved group or unit. After many years as Chair, Tom Chiu has embarked on another phase of his academic career- having accepted the position as Professor of Pediatrics responsible for “External affairs,” being concomitantly appointed to the Board of Directors of Wolfson Children’s Hospital. Those of us who have been most fortunate in having been in a vantage point of following his academic career, anticipate a future constellation of achievements. v

From Sun Tzu to Colin Powell By Jeffrey Goldhagen, MD

Professor and Chief, Division of Community and Societal Pediatrics University of Florida College of Medicine—Jacksonville

The general who wins the battle makes many calculations in his temple before the battle is fought. The general who loses makes but few calculations beforehand. Sun Tzu There are no secrets to success. It is the result of preparation, hard work and learning from failure. Colin Powell

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or those as ignorant as I about the meaning of Festschrift, it should come as no surprise that it is a term derived from German. A ‘feast-script’ is a book honoring a respected person, especially an academic during her or his lifetime. The term is translated from German as a celebration publication or celebratory (piece of ) writing. A comparable book presented posthumously is called a Gedenkschrift (memorial publication). This contribution to the celebratory publication for Tom is meant to be a Festschrift for the leadership he has shared with our community and profession over the past several decades. Medicine has changed much during Tom’s tenure in pediatrics. If the leaders who inherit our profession are to succeed, they will need to understand the history of

the stewardship that has defined it. Without this perspective of what has so profoundly influenced the trajectory of pediatrics over the past half century, it will be impossible to sustain the contributions of Tom and others throughout our country.

Through the Lens of History “In the midst of chaos, there is also opportunity.” Sun Tzu “Perpetual optimism is a force multiplier.” Colin Powell So to begin, it’s necessary to understand Tom’s contributions to our community and pediatrics through a lens of history. Over the decades there have been several clearly delineated periods of change in pediatrics. Beginning in the 1950s, Contemporary Pediatrics emerged through the scientific breakthroughs of the day in infectious diseases and nutrition. The clinical practice of “General Pediatrics” by spe-

cialist pediatricians was now possible, as pediatricians could offer children periodic vaccinations, antibiotic treatment for common infectious diseases, and nutritional interventions using the then new “scientific” infant formulas. (To the detriment of breastfeeding, but that is fodder for another manuscript) Barbara Korsch, M.D. and others were instrumental in launching this “new” approach to the practice of pediatrics. In the 1970s, a focus on “Psycho-Social Pediatrics” was launched, with the understanding that children live in families and social environments, and that these needed to be considered in the context of pediatric practice. Joel Alpert, M.D. and Evan Charney M.D. were among the luminaries that championed the integration of psycho-social pediatrics into the practice of general pediatrics. Subsequently, in the 1990s “Community Pediatrics” was launched by Robert Haggerty, M.D. in response to the accumulating evidence that pediatricians required multiple community resources beyond the scope and walls of their practices to advance the health and well-being of children and families. Indeed, children lived in communities, and “place” impacted their health and well-being. Parallel changes were also happening in the domains of subspecialty pediatrics during these decades. The sub-specialization of behavioral

A Festschrift in Honor of Thomas Chiu, MD

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Some of the Neonatal Nurse Practioners who were trained in the Neonatal Nruse Practioner Program started by Dr. Chiu.

and developmental pediatrics, adolescent medicine, school health, mental health, etc., began to balkanize the primary care and treatment of children. Concurrent advances in science also resulted in the generation of multiple organ-specific subspecialties. This was the historical pedigree of pediatrics that Tom inherited as he ascended to the chairmanship. It was complicated and political, and so too were the schisms in medicine and academia in Jacksonville— schisms that were deeply embedded in the culture of our community. Schisms that impacted the health and well-being of our children. First and foremost was the shadow of racism and segregation. Though these remain critical determinants of children’s health and well-being today, there had been little acknowledgement of these issues in Jacksonville, and even fewer attempts to respond as Tom emerged as chairperson. Ignorance, neglect, bias and discrimination

contributed to great disparities in child health—disparities that established the metrics of our children’s health as among the worst in the country. HIV, crack cocaine, the villainizing of adolescents (in particular black youth), high and disparate infant mortality rates, and poor access to health care defined the challenges confronting our children and youth. Significant divisions existed in our health care system. The political and organizational divides between Nemours, the University of Florida in Gainesville, the UF Department of Pediatrics in Jacksonville, Wolfson Children’s Hospital, University Hospital, the public health department, the Duval County Medical Society and Black physicians, hospitals, etc. created a complex set of challenges to any individual or organization committed to improving the health and well-being of children. The challenges to individuals who were so committed, but who worked in institutional settings whose focus was on other political and financial agendas, was even more pronounced. In addition to the above, there were many gaps in access to community and subspecialty pediatric and child health services. There was virtually no access for low-income minority children to quality primary care services. Most Spanish speaking families lacked access to community pediatricians who spoke Spanish. Dental care for low-income children was essentially non-existent. Poor availability

A Festschrift in Honor of Thomas Chiu, MD

to vaccines resulted in dismal immunization rates. Developmental and behavioral pediatric care was inaccessible to virtually all children. Subspecialty care in a number of subspecialties was sparse or non-existent. Inexcusable numbers of uninsured children lacked basic health care services—access to care was distributed primarily by race and income. If you were an undocumented child, few health care resources were available. With respect to the core functions of academic medicine, our residency program had difficulties attracting the highest quality of residents, research output was low, the economic foundation of the department was weak, there were no fellowships in place, recruitment of high quality faculty was difficult, and there was little national and/or international presence of the department and its faculty. The Jacksonville campus was a subsidiary of Gainesville with little independence and a “Cinderella” complex. This was the environment that Tom inherited when he became chair—this petite, Ghandiesque, Asian American neonatologist—with a keen sense of equity and social justice, and a repertoire of leadership styles and skills limited by culture, demeanor, personality and a commitment to the holistic health of children. Ironically, it was this limited skill set, as it turned out, that allowed Tom to address—without distraction, arrogance, or agendas—all of the challenges noted above to advance the health and well-being of children and families, transform the Department and faculty, and help heal the fractured child health system.

Lessons Learned “The greatest victory is that which requires no battle.” Sun Tzu “Being responsible sometimes means pissing people off.” Colin Powell So what lessons can we learn from the tenure of Tom’s leadership that is relevant to the future of pediatrics and pediatric leadership in our region and country? Lesson 1: Focus on the whole child. The mission of academic pediatrics is to train pediatricians by fulfilling, in all respects, the holistic role of the pediatrician for all children. This role is defined by the American Academy of Pediatrics, and has been promulgated by Tom throughout his career. • The pediatrician is concerned with the physical, mental and social health of children from birth to young adulthood. • Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.

A Festschrift in Honor of Thomas Chiu, MD

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• Pediatrics is a discipline that deals with biological, social and environmental influences on the developing child and with the impact of disease and dysfunction on development. • A pediatrician is a physician who is primarily concerned with the health, welfare and development of children and is uniquely qualified for these endeavors by virtue of interest and initial training. • Because the child’s welfare is heavily dependent on the home and family, the pediatrician supports efforts to create a nurturing environment. • A pediatrician participates at the community level in preventing or solving problems in child health care and publicly advocates the causes of children. Tom taught us that to address the whole child; pediatricians and academic institutions that train them must advocate for children in the domains of the clinical environment, community, system development, and public policy. Lesson 2: Advance children’s rights, health equity and social justice. The practice of pediatrics is the pursuit of children’s rights to: 1) Optimal survival and development, and 2) to the enjoyment of the

highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Tom worked to advance health equity and social justice by ensuring the opportunities and resources existed for all children to achieve optimal health outcomes. Lesson 3. Concentrate on the best interests of children. The best interests of children must be the primary consideration for decisions by pediatric leaders, not competing political or bureaucratic interests. Tom never asked “why,” but always “how” when he was convinced a policy or program would improve the well-being of children and families. Lesson 4: Lead, don’t manage. Leadership is inherently different than management. Leaders: 1) Create value, they are not focused on measuring it; 2) Expand circles of influence, not the exercise of power; 3) Lead people, not manage work, and 4) Communicate and trust. Tom provided confidence that the future is defined by possibility, inspired innovation, developed others in his pursuit of a vision, and always lead and let others manage. Lesson 5: Establish a creative climate. Draw from the philosophy of the ages—from the wisdom of Sun Tzu to that of Colin Powell. Tom surrounded himself with people with a breadth and depth of skills, and provided them space and the autonomy to accomplish great things.

A Festschrift in Honor of Thomas Chiu, MD

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Lesson 6: Practice servant, laissez-faire and transformational leadership. Successful leadership demands the application of multiple leadership styles, depending on the challenges being faced and the skills of the team assembled. Tom: • Put service to others ahead of self-interest. • Included his whole team in decision-making. • Recruited competent people and trusted them. • Established a committed and cohesive team. • Knew what was happening, but wasn’t controlling. • Demanded all to give their best. • Expected transformational change, even in the face of significant challenges. • Served as a role model. Lesson 7: Understand and use bureaucracies; the system is the solution. Bureaucracies are established to sustain organizational integrity and support incremental change. When bureaucracies failed to consider the best interests of children, violated their rights, and/or didn’t respond to issues of equity and social justice, Tom addressed them without hesitance. His diplomacy, in this regard, was measured, focused, respectful and tenacious.

Lesson 8: Rewards are commensurate with risk. In order to respond to the overwhelming challenges facing children and families, our Department, health systems, and public policy—Tom was comfortable with individuals and the Department taking risks and failing on occasion. Lesson 9: Take the long view. Consider the effects an action or inaction will have in the future instead of the present. Tom encouraged his leadership team to effect change with a long-term perspective, and to accept incremental steps in pursuit of ultimate goals and objectives. Lesson 10: Support your faculty. Those on whom you depend to accomplish a common vision and mission deserve your full and transparent support, and always the benefit of doubt. Tom was uncompromising in his commitment to the Department’s faculty, residents, fellows and staff. There are many examples of how Tom operationalized these precepts—enumerating them is beyond the scope of this Festschrift. And, there are also lessons to be learned by Tom’s shortcomings. As an example, during the 20 years of his leadership, the Department never had a rigorous strategic plan. There were thus too few opportunities for inter-divisional collaboration that responded to Departmental strategic goals. Also, Tom could not keep a secret—occasionally it was not possible to keep him informed of developing programs that required time to mature. Conversely, this was also a valuable asset—if

A Festschrift in Honor of Thomas Chiu, MD

you wanted to ensure the community knew about a particular issue, all one had to do was ask Tom to keep it confidential!

Why a Festschrift? “Opportunities multiply as they are seized.” Sun Tzu “You don’t know what you can get away with until you try.” Colin Powell The importance of this Festschrift is not so much to honor Tom in words, but rather through the application of the lessons his leadership has to teach. And unfortunately, there remain far too many opportunities to employ these lessons—as much of the history Tom inherited remains our reality today. There has been some progress to be sure, but health disparities continue. Our children still bear the burden of discrimination based on race, ethnicity, gender, class and immigration status. Structural racism continues to dominate our culture. Income inequalities that so profoundly impact children’s health are growing. Our health systems remain fractured. And, new social and environmental determinants of health are emerging.

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If pediatrics is to remain relevant, we must understand and respond to the historical trajectory of our profession—a trajectory that Tom understood well. If we are to succeed as pediatricians, lessons learned from Tom during the past two decades must be applied to the emerging challenges facing children and our community. New tools and strategies that incorporate Tom’s commitment to the principles and norms of child rights, health equity and social justice will be required to address these emerging childhood morbidities. And so, this is why this Festschrift is so important. The lessons learned from Tom’s presence and work have the potential to ensure we succeed in responding to the challenges we face as pediatricians well into the future. If we fail to fulfill this potential, we risk the fate of this Festschrift morphing into a Gedenkschrift for what Tom and others have accomplished. The challenge that confronts us now is to learn from history and apply what we have learned from Tom to our practice of pediatrics, education of residents, research, child advocacy, systems development, and public policy. History doesn’t end, it continues to be created. Thank you, Tom for your wisdom and grace. And, thank-you Anna, Charmaine and Christine for sharing Tom with us. v