U of T Medicine — Fall 2013

Teaching surgical skills using a computer and Internet connection Scalpel, Scissors and Skype

Indigenous health initiative brings cultural clarity to blind spots in care Ignored No Longer

Mobile health unit is breaking down barriers for immigrant women On the Road to Health

Assisting people with disabilities across the globe Opening the Circle

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FALL 2013

SECTION HEADER

“My U of T scholarship makes it possible for me to participate in extracurricular activities that will prepare me for the career I’m so passionate about.”

Sabrina Nurmohamed MD 2015

Your support of the Boundless campaign ensures we continue to nurture the limitless potential of medical students like Sabrina.

By giving to the Faculty of Medicine, you help us prepare the next generation of doctors and global citizens to create a healthier future for Canada and the world.

Donate or find out more at: donate.utoronto.ca/medicine or 416-946-3111 boundless.utoronto.ca/medicine

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PHOTO CREDIT: PHOTOGRAPHER/PHOTO STUDIO

INSIDE THIS ISSUE

Contents PUBLISHER Lloyd Rang EDITOR-IN-CHIEF Nicole Bodnar ART DIRECTION + DESIGN Raj Grainger

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9 Scalpel, Scissors & Skype Teaching surgical skills using a computer and Internet connection

10 Pandemic 3.0 U of T is helping remodel the global public health system and preparing for the next health crisis COVER PHOTO: GETTY IMAGES

— PUBLISHED BY University of Toronto Faculty of Medicine

Facebook: U of T Medicine Twitter: @UofTMedicine Instagram: @UofTMedicine YouTube: UofTMed

16 6 News@Medicine

ACADEMIC LEAD Sarita Verma

6 Queen’s Park Crescent West, Suite 306, Toronto, ON M5S 3H2 Phone: 416-978-7752 Fax: 416-978-6999

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4 Snapshots

CONTRIBUTORS Liam Mitchell, Jim Oldfield, Suniya Kukaswadia, Meera Rai, Roberta Brown, Teona Baetu

16 Ignored No Longer New indigenous health initiative brings greater cultural clarity to blind spots in care

E-mail: medicine.communications@utoronto.ca

27 Q&A Sheila Wijayasinghe is breaking down barriers for immigrant women

The University of Toronto respects your privacy.

We do not rent, trade or sell our mailing lists. If you do not wish to receive U of T Medicine magazine, please contact us.

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28 Alumni Profile 18 Delivering Better Maternal Health in Kenya 22 Opening the Circle How U of T Medicine assists people with disabilities across the globe

How a decorated Surgeon General represents U of T Medicine in the Canadian Forces

BONUS CONTENT Look for these icons throughout this issue and visit our website for bonus photos, videos and stories: uoft.me/medmag

29 Old School Global health pioneer Norman Bethune

Fall 2013 — 1

FROM THE DEAN

Why is the Faculty of Medicine focusing on global health?

OVER THE PAST FEW DECADES, AS globalization has made our world seem like a smaller, more interdependent place, we have become more aware of the need for a broad, global perspective on health. Low income, inadequate access to healthy food and the continued use of tobacco are just a few of the underlying issues that, combined with socioeconomic factors, impact the health of Canadians and people around the world.

We responded to these challenges in our 2011 Roadmap for Global Health, and that strategy informs the activities you will read about in this special global health issue of U of T Medicine.

Consistently, our efforts as a Faculty are focused on addressing issues of health, poverty and inequality both close to home and around the world. Our admittedly ambitious goal draws from our strengths as Canada’s leading faculty of medicine in innovative discovery, applied health research, knowledge translation and interprofessional education. Our goal is to identify and close the gaps in health, address inequities through research and workforce supply, and to contribute to the scientific knowledge and understanding of the global community.

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All facets of the Faculty of Medicine — students, faculty, staff and all our departments and networks — are engaged in this endeavour. Our partnerships extend beyond the university’s network to new and existing international partners in Stockholm, São Paulo, Munich, Addis Ababa, Beijing and, of course, locally in Toronto and Ontario.

We also salute our newest partner Faculty — the Dalla Lana School of Public Health — which became a stand-alone Faculty in July 2013.

It re-emerged from the Faculty of Medicine, its home since 1975, ready to assume academic independence.

The priority that the University of Toronto has placed on public health in support of the Dalla Lana School of Public Health has enabled collaborative growth in priority areas, particularly global health and family and community medicine. I have invited Professor Hu to provide his Dean’s Message in this issue of U of T Medicine.

In this magazine you will read about efforts in research, education and care, and the execution of our strategic directions resulting in positive change. While there is always more to do, I continue to be inspired by the leadership that our Faculty is taking as we do our part here in Toronto to bring better health for all people around the world.

Catharine Whiteside B.Sc. ’72, MD ’75, PhD ’84 Dean, Faculty of Medicine Vice-Provost, Relations with Health Care Institutions

FROM THE DEAN

THIS PAST JULY, THE DALLA LANA School of Public Health emerged from the Faculty of Medicine to become the first new Faculty at the University of Toronto in 15 years. In so doing, alumni who trained in the public health sciences from decades past and into the future will no longer automatically receive U of T Medicine, but we are committed to finding innovative ways of keeping our communities engaged.

A Roadmap for Global Health

Why? As this special issue amply demonstrates, Medicine and Public Health will remain forever connected.

Many readers have careers that blend both areas; scores of professors in our respective Faculties have joint appointments; and collaborations across the spectrum of clinical and public health sciences will be essential to address the enormous challenges to health of the 21st century.

Many of these challenges reside in global health. As Dean Whiteside said, efforts need to be “focused on addressing issues of health, poverty and inequality, both close to home and around the world.” This will require attention to populations, prevention, public health policy and the care of individuals.

The Faculties of Public Health and Medicine are forging innovative ways to collaborate and blend like never before, rather than work in silos. A great example is the new Division of Clinical Public Health, dedicated to “developing, testing, evaluating and teaching approaches to integrating primary care, preventive medicine and public health.” The Division is led

by Professor Ross Upshur, a Canada

Research Chair in Primary Care, and a partnership with the Department of Family and Community Medicine, Public Health Ontario and other clinical and public health units to field test innovations in Toronto, Beijing, Addis Ababa, São Paulo, rural communities and elsewhere with our global partners.

There are many other innovations in progress related to healthier cities, big data, massive open online courses, continuing education, Aboriginal health, genomics and epigenomics, new undergraduate and joint degree programs and more. Visit our website (www.dlsph.utoronto.ca), where you can sign up for our e-Bulletin.

Whether trained in medicine or public health, we invite you to keep in touch, participate, learn, contribute and innovate.

STAY IN TOUCH! Send your e-mail address to dean.dlsph@utoronto.ca to receive future updates from the Dalla Lana School of Public Health.

Howard Hu MD, MPH, ScD Dean, Dalla Lana School of Public Health Fall 2013 — 3

FACULTY OF MEDICINE IN PHOTOS

Snapshots Former NHL legend Mats Sundin with Sophie Petropoulos (left) and Jessica Weidner (right), 2013 Mats Sundin Fellows in Developmental Health.

PHOTO: CANADIAN EMBASSY IN SWEDEN.

A first-year

MD student reads a Words of Wisdom letter written by a Faculty of Medicine alumnus during Orientation Week. PHOTO: MARK WLODARSKI.

Pablito Agustin

and his family celebrate at Convocation. PHOTO: RAJ GRAINGER.

Dean Catharine Whiteside with

Professor Adalsteinn Brown — Director, Institute of Health Policy, Management and Evaluation — at his welcome event. PHOTO: HORST HERGERT. U of T’s Surgical Exploration and Discovery (SEAD) students repair a mock vein by sewing in a graft with guidance from Professor George Oreopoulos (Department of Surgery). PHOTO: NEIL D’SOUZA.

(From left to right) Paul Garfinkel

(Chair of the Department of Psychiatry’s Campaign Cabinet), Jacquie Labatt (member, Department of Psychiatry Campaign Cabinet) and The Honourable Michael H. Wilson, Chancellor of U of T, at the Department of Psychiatry’s internal Boundless campaign launch event. PHOTO: FELIX CHAN. 2013 Staff IMPACT Award winners. Left to right (top row): Tim Neff, Helena Friessen, Joan McKnight, Judy Irvine, Artur Jakubowski, Catharine Whiteside.

(Front row, with plaques): Patricia O’Brien, Caroline Abrahams, Lesley Ward. PHOTO: HORST HERGERT. Class of 1T7 students at their Stethoscope Ceremony, which took place during Orientation Week. PHOTO: FACEBOOK.

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SNAPSHOTS

Follow us on Twitter, Facebook and Instagram @UofTMedicine to see more alumni, faculty and students in action.

Fall 2013 — 5

GLOBAL HEALTH

News@Medicine Instagram for Doctors Alums create a medical photo sharing app Two Faculty of Medicine alumni, Joshua Landy (Department of Medicine) and Daniel Krofchick (Institute of Medical Science; B.Sc. ’99, M.Sc. ’02, PhD ’ 12), developed Figure 1 — a free iPhone application that crowd sources medical images. The app has quickly gained tens of thousands of users and its creators hope it becomes an open access library for health professionals.

Three U of T Professors appointed to Order of Canada GOVERNOR GENERAL DAVID Johnston appointed Professors Arnold Noyek (Department of Otolaryngology — Head & Neck Surgery; MD ’61), Thomas Hudson (Departments of Molecular Genetics and Medical Biophysics) and Dafydd Rhys Williams (Department of Surgery) as Officers of the Order of Canada.

The Order of Canada is the country’s highest civilian honour and recognizes their outstanding lifetime achievements.

Attention social media followers Use the hashtag #UofTMed on Facebook, Twitter and Instagram and enter to win U of T Medicine swag!

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FACULTY OF MEDICINE NEWS

A New Faculty Emerges On July 1, 2013, the Dalla Lana School of Public Health became its own Faculty.

“With one of the country’s largest concentrations of population and public health researchers, U of T is right at the geographic, political and institutional nexus of public health and the ideal home for a place like the Dalla Lana,” said Howard Hu, Faculty Dean.

The School is a leader in public health education, research and service. More than $30-million in research funding supports discovery in global health, tobacco impacts on health, public health policy, occupational disease and disability, air pollution, genomics, inner-city health and circumpolar health.

Celebrating Convocation Brian Li was one of 218 MD graduates who donned the traditional cap and gown for convocation on June 4, 2013.

“I’m excited to graduate, but even more excited for my internal medicine residency and the learning opportunities yet to come.”

BONUS: VIDEO uoft.me/medmag

ALL-NIGHT ART EXHIBIT, POWERED BY U OF T RESEARCH, WOWS CROWD MY VIRTUAL DREAM — AN ART EXHIBIT FUELLED BY Professor Randy McIntosh’s (Institute of Medical Science) research — dazzled Nuit Blanche attendees on October 5, 2013, by providing a unique sensory experience combining art, science and technology.

The exhibit was powered by The Virtual Brain — a computer model that captures the human brain’s structure and function — that McIntosh hopes will transform the diagnosis and treatment of neurological disease.

PHOTOS: (TOP) ROB WAYMEN, (LEFT) COURTESY OF BRIAN LI, (RIGHT) RAJ GRAINGER

Learn more about My Virtual Dream and U of T’s Neuroscience and Brain Health Network on our YouTube Channel (UofTMed).

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INTERNATIONAL PARTNERSHIP

Tackling health challenges glo-cally How can the treatment of a man with coronary artery disease in Toronto also help a South American patient with diabetes, and vice versa?

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Toronto

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Colombia THROUGH A PARTNERSHIP BETWEEN U of T and the University of São Paulo (USP) in Brazil, researchers are applying a global lens to heart disease.

“By partnering with one of South America’s most renowned universities, U of T bridges two strong institutions with distinct strengths. USP treats a wide spectrum of socioeconomically and ethnically diverse patients,” said Michael Farkouh, Director of U of T’s Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research.

“Leveraging the resources of two robust urban centres strengthens our ability to answer important cardiovascular questions, like how diabetic patients respond differently to standard treatments.”

Farkouh is leading collaborations with USP by matching U of T investigators with Brazilian counterparts — particularly those studying heart failure and minimally invasive treatment techniques — on a one-to-one basis. This team-based model is a win-win because it helps junior scientists learn to work as a unit.

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GRU

São Paulo

“With a bench-to-bedside translational approach and a diverse local population, we’re able to study large populations of patients right here in Toronto,” said Farkouh, who says his international relationships not only further his research, they also make him a better doctor.

Farkouh also organized a symposium in São Paulo in July 2013 that expanded the range of collaborations to include Dalla Lana School of Public Health faculty matched with USP counterparts, who have since developed a robust agenda

of research on how air pollution affects cardiovascular disease.

“Idea exchange and collaboration are powerful assets when attracting research funding, but it requires mutual respect and investment. I have learned so much as visiting professor in Brazil and other international institutions and this knowledge transforms the way I approach my patients.” — NICOLE BODNAR

GLOBAL HEALTH

KBP

Ukraine

GBE

Botswana

Scalpel, Scissors & Skype How a U of T surgeon is teaching surgical skills using a computer and Internet connection IT WAS A STORY OF FAILURE AND redemption.

In the spring of 2007, Allan Okrainec spent two weeks in Botswana with his colleague Georges Azzie, an Assistant Professor in the Department of Surgery, using a simulator to teach laparoscopy, a minimally invasive surgical technique that limits patient pain and improves recovery time. Only two of 20 doctors passed ILLUSTRATION: LUKE PAUW

BONUS: VIDEO & PHOTOS uoft.me/medmag

professionals in 13 countries in his role as Director of the Temerty/ Chang International Centre for Telesimulation and Innovation in Medical Education at University Health Network.

“Allan is really a global leader in telesimulation. He’s helped drive a the Fundamentals of Laparoscopic surge in training across specialties Surgery certification test. to address health inequities around Later that year, Okrainec and Azzie the world,” said Dimitri Anastakis retrained the same group remotely (B.Sc. ’84, MD ’88), Vice Dean from Toronto, using Skype once a of Continuing and Professional week for eight weeks. This time, all 20 Development in the Faculty of passed the exam.

Medicine, and President and CEO of Known as telesimulation, the SIM-One, a not-for-profit organization new education technique allows that aims to position Ontario as the medical trainees in remote areas global leader in health care simulation. and developing countries to build Despite the challenges of their clinical skills with real-time telesimulation in global health, guidance from teachers miles including funding, and time zone and or continents away. The only language differences, this technology requirement is an Internet connection, is set to play an even bigger role in computer and camera at each end.

21st-century medical education.

“A week or two is often not enough Telesimulation is now also being used time to teach a complicated skill,” said to teach skills in emergency medicine, Okrainec, an Associate Professor in anesthesia and even surgical nursing the Department of Surgery. “But with skills. telesimulation, we can give learners The Temerty/Chang Centre recently feedback so they don’t repeat mistakes, set up teacher-training satellites in and because the training is distributed Colombia and Ukraine, and will soon over a longer period, retention is open one in China. better.”

“We can’t train the world, but we Since 2007, Okrainec has can train the trainers,” said Okrainec. helped train more than 250 health — JIM OLDFIELD Fall 2013 — 9

Kamran Khan at the Li Ka Shing Institute with BioDiaspora

From SARS to H1N1, the world has seen several infectious disease outbreaks in the past decade.

U of T is helping remodel the global public health system and preparing Toronto for the next health crisis.

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PHOTO: JACKLYN ATLAS

COVER STORY

— BY DAVID MCLAUGHLAN

SHE JUST WANTED TO MAKE SURE HER HUSBAND WOULD be all right. The elderly couple entered a Toronto hospital worried that he might be experiencing a heart problem.

They checked in, sat in waiting areas and received care.

It was 2003 and Severe Acute Respiratory Syndrome — or SARS — had arrived in Ontario’s health care system, via an overseas visitor. The unsuspecting elderly couple had contracted the virus during an earlier hospital visit, and now carried it into a second.

BIODIASPORA IMAGE COURTESY OF KAMRAN KHAN

The woman was what is known as a “super spreader”: a patient who doesn’t show symptoms, but passes along a large amount of virus. U of T infectious disease experts who later traced the virus’s spread identified her as the vector that transmitted the virus to three admission clerks, a security guard, five visitors, three nurses and a housekeeper.

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For the next potential crisis, we have to be prepared for the unknown.

TEN YEARS AGO, FEW HEALTH SYSTEMS WERE WELLprepared for a jet-setting infectious disease and super spreaders in their midst. Most other cities got off with a warning, but in Toronto, there were serious consequences.

The SARS virus caused 44 deaths and struck down more than 330 others with serious lung infections. When the crisis cleared, Ontario’s public health system was put under the microscope.

“If that elderly couple walked into a hospital today during a similar outbreak, they’d get the care they need, but the health of others would be more carefully protected,” said Vivek Goel (M.Sc. ’88), Professor in the Dalla Lana School of Public Health, and President and CEO of Public Health Ontario, the agency that supports the development of a coordinated pandemic response plan.

“For the next potential crisis, we have to be prepared for the unknown. That’s the real challenge in public health,” Goel said.

In the global fight against infectious disease, U of T is providing significant knowledge and expertise in identifying new threats, predicting their spread and delivering vital information to front-line health workers.

ON SEPTEMBER 24, 2012, A VIROLOGIST IN JEDDAH, SAUDI Arabia, reported the existence of a novel coronavirus, which has become known as Middle East Respiratory Syndrome (MERS). It’s from the same family of viruses as SARS, so perhaps it’s not surprising that soon after, phones were ringing in Toronto.

Allison McGeer (B.Sc. ’74, MD ’82) was one of those contacted. She is a Professor of Laboratory Medicine and Pathobiology and head of infection control at Mount Sinai Hospital. McGeer was on the front lines in 2003 — helping to control the spread of SARS; even contracting the disease herself.

McGeer travelled to the Arabian Peninsula twice this spring to support the investigation of a large hospital outbreak and to participate in a World Health Organization review of the state of knowledge about MERS. “The critical piece of understanding any outbreak is finding the reservoir — where the virus or bacterium naturally lives — and figuring out how it is passed from that reservoir to humans,” said McGeer, also a Professor in the Dalla Lana School of Public Health, noting that for MERS, it’s a painstaking investigation.

“The people who are infected with MERS have been very seriously ill and many have died. Quite a number have been transferred to ICUs in distant countries before their diagnosis.”

Tracking the source means in-depth interviews, including hundreds of questions that aim to track every aspect of each patient’s movements prior to the infection.

Were they in contact (even briefly) with animals? Did they visit the same market, eat the same food, drive past the same construction site or fountain?

Since SARS, the old-fashioned detective work of patient interviews has been complemented by improved investigative technologies. “At the time of SARS, there were

Vivek Goel in Public Health Ontario boardroom 12 — U of T Medicine

PHOTO CREDIT: PHOTOGRAPHER/PHOTO PHOTO: JACKLYNSTUDIO ATLAS

COVER STORY

Allison McGeer in Mount Sinai Hospital’s Microbiology Laboratory

few labs available for genetic sequencing,” said McGeer.

“It took a week and cost up to $2,000 per patient. Now, it’s quicker and about one-tenth the cost. Genetic information allows us to learn how the pathogen is evolving, how quickly it’s changing and how meaningful are the changes.”

McGeer is confident that warnings on MERS will be heeded around the world, in part due to the work of many experts at U of T after SARS. “Before SARS, doctors were more focused on individual patient symptoms rather than on epidemiology — where and to whom the patient may have been exposed. Now, we’re better at communicating infectious disease information to physicians, and I think doctors everywhere think about it more when seeing a patient.”

TELL KAMRAN KHAN (MD ’96) WHERE YOU’VE BEEN IN THE world and he can probably tell you how you got there. A Professor in the Department of Medicine, Khan is another U of T researcher whose expertise has been called in to monitor MERS. He created a tool called BioDiaspora, which tracks the spread of infectious disease through the movements of international travellers.

PHOTO: JACKLYN ATLAS

Looking back, it seems the motivation to develop the technology wasn’t hard for Khan to find; one could say it found him. In 1999, he was working as an infectious disease expert in New York when West Nile virus hit the city. Then, in 2003, he moved to Toronto. Within a few months, he was treating patients with SARS, which affected his own hospital.

“These experiences had a profound effect on my work as a scientist. It was clear that the global spread of infectious diseases didn’t follow random patterns. They were spreading according to global transportation networks,” said Khan, who is also a scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

He began working with the airline industry to build a database that presently includes almost twenty billion flight itineraries — the air traffic circulatory system that spreads infectious disease throughout our global civilization. Working on the front lines also convinced him that the academic study of outbreaks — after the fact — was not enough.

“During an outbreak, timeliness and precision are everything. Governments and public health officials Fall 2013 — 13

During an outbreak, timeliness and precision are everything. needed better tools to anticipate and respond to outbreaks,” said Khan.

Since its creation, BioDiaspora has been used by the Public Health Agency of Canada and the U.S. Centers for Disease Control and Prevention, among other governments around the globe. During the London Olympics it was used to conduct real-time risk assessments for infectious disease threats in partnership with the British government.

“Most of us have been trained to think about infectious diseases circulating in our own backyard, but in just a few decades our backyard has become the entire globe.

By leveraging big data and cutting-edge science and technology we can better prepare ourselves for infectious disease threats in an increasingly interconnected and interdependent world,” said Khan.

U OF T EXPERTISE IS NOT ONLY IMPROVING SURVEILLANCE of global threats, it is improving the global response.

In Toronto, on the ninth floor of an office building at the corner of University Avenue and Dundas Street, there’s a room where public health staff gather each day to monitor real-time infectious disease reports from around the world.

MERS was on their radar as soon as it was reported and plans for an effective, efficient response got underway soon after.

SARS advanced public health on the public policy agenda in Ontario. President David Naylor, also Dean of U of T’s Faculty of Medicine from 1999 to 2005, led the federally sponsored National Advisory Committee on SARS and Public Health. He called SARS a “reminder, warning and opportunity” to renew public health.

In Ontario, there were two SARS inquiries, one led by retired Justice Archie Campbell, the other by David Walker, then Dean of Health Sciences at Queen’s University, that both recommended, among other things, the creation of a health protection and promotion agency — which became Public Health Ontario — led by Goel.

“Public Health Ontario can now identify expertise and quickly get the right people around a table to identify infectious disease threats and advise health professionals,” said Goel.

Michael Gardam (M.Sc. ’03), Professor in the Department of Medicine, worked closely with Goel during the fall of 2009 when H1N1 was a looming threat to Ontario’s health care system. Serving as Public Health Ontario’s Director of 14 — U of T Medicine

BONUS: STORY uoft.me/medmag

Infectious Diseases, Gardam helped develop early guidance protocols, but his role quickly shifted to one of educating the public about what was happening.

“People felt they were not hearing what they needed to hear during the H1N1 pandemic,” said Gardam, who is also Director of Infection Prevention and Control at University Health Network and Women’s College Hospital.

“My role was to translate what was being officially said into language that was easy to understand and to acknowledge when there were unknowns and controversies,” said Gardam, noting he learned this approach from his mentor, the late Don Low, who is considered by many to have been the voice of SARS. Public Health Ontario’s headquarters — the Sheela Basrur Centre — is a busy, professional environment. Staff monitor infectious disease reports and scour academic journals, looking for promising research that might someday be a useful resource in a crisis. Epidemiologists explore new techniques, such as using Google Analytics in an outbreak. Communications advisors look for ways to better connect with the public.

The location of Public Health Ontario is a deliberate choice. “We’re situated near U of T and academic health science centres so we have access to concentrated scientific knowledge,” said Goel. “In a crisis, we need proximity so we can bring in expertise, create clear instructions for frontline staff, get it right and do it fast.”

Dozens of medical and scientific staff have been added since 2003. New laboratory technology has been installed.

Test turnarounds are now measured in days and hours, rather than the weeks it might have taken prior to SARS. Goel points out that Public Health Ontario models itself like a U of T teaching hospital — graduate students from many disciplines are encouraged to work and learn together at the agency.

“We are especially excited to train medical students.

When they become physicians — whether as family doctors or in a hospital setting — they will have a stronger understanding of their role in public health.”

Goel, McGeer and Khan all point to examples of improved pandemic preparation.

International reporting of infectious disease is improved.

Coordination at home is better and there are clearer lines of authority. However, they also stress the need for constant vigilance and increased knowledge in an uncertain world.

SOCIAL DETERMINANTS OF HEALTH

BONUS: PHOTOS uoft.me/medmag

Wealth = Health But why?

Poverty increases the risk of disease. But the reason why a low income can have such a dramatic effect on health is not clear.

Stephen Hwang and Richard Glazier ILLUSTRATION: LUKE PAUW

AFTER MORE THAN A DECADE OF intensive research, we know that many factors conspire to link income and health — some of which are obvious, such as stress and poor access to healthy food.

Earlier this year, Stephen Hwang exposed a surprising new factor.

Hwang, a Professor in the Department of Medicine, led a study that found family doctors’ offices are more likely to give first-time appointments to patients with a high income than those with a low income.

“Even though family physicians in Canada’s single-payer health care system have no economic incentive to discriminate based on socioeconomic status, we found that some offices favour people who have higher income,” said Hwang, who is also a scientist in the Centre for Research on Inner City Health of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

Hwang’s team contacted 375 doctors’ offices in Toronto posing as either a bank employee newly transferred to the city or as a welfare recipient. Those presenting themselves as bank employees were almost 80 per cent more likely to get an appointment.

The study was the first in Canada to find discrimination based on economic status — a phenomenon that Hwang, who works half a day per week at a homeless shelter, had long suspected was real.

Richard Glazier, a Professor in the Department of Family and Community Medicine, recently found evidence of another income-linked determinant of health: neighbourhood walkability.

NEIGHBOURHOOD WALKABILITY According to Mike Evans (B.Ed. ’12), Assistant Professor in the Department of Family and Community Medicine and Dalla Lana School of Public Health, walking is the single best thing we can do for our health.

Glazier and colleagues showed that recent immigrants living in areas less conducive to physical activity — those with few amenities and recreational facilities, where travel by car is common — had a threefold risk of developing diabetes.

“Poor walkability and low income can create a perfect storm that raises the risk for diabetes, particularly among recent immigrants,” said Glazier, who is also a scientist in the Centre for Research on Inner City Health of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

Peel and other regions around Toronto have begun to identify and make changes to low-income neighbourhoods with poor walkability, based on the work of Glazier and his colleagues.

“Zoning changes that allow for more density and commercial space encourage people to walk when running errands, rather than drive, and can quickly turn an unhealthy neighbourhood into a more active one,” said Glazier. “The progress has been encouraging.”

By exposing some of the indirect ways that low income negatively affects health, U of T researchers are helping to ensure marginalized populations can access the health care they need. — JIM OLDFIELD Fall 2013 — 15

GLOBAL HEALTH

BONUS: STORY uoft.me/medmag

16 — U of T Medicine

Jason Pennington, Cat Criger (U of T Aboriginal Elder) and Rochelle Allan (Indigenous Peoples’ Program Coordinator) outside Medical Sciences Building

CULTURAL SAFETY

He arrived with a treatable bladder infection caused by a blocked catheter, but after waiting 34 hours for care in a Winnipeg hospital, 45-year-old Brian Sinclair was dead. Was this the result of an overburdened health care system? A poor initial assessment of Sinclair’s condition? Or, was it because Sinclair was Aboriginal?

Ignored No Longer New indigenous health initiative brings greater cultural clarity to blind spots in care.

“Creating a foundation of trust between the patient and caregiver can improve health outcomes by ensuring a more realistic treatment plan and a greater likelihood the patient will adhere to it.”

PHOTO: JACKLYN ATLAS

AN INQUEST IS UNDERWAY, BUT THE CASE SHOWS THE need for a deeper understanding of indigenous health, argues Jason Pennington (B.Sc. ’94, M.Sc. ’96, MD ’00), Lecturer in the Department of Surgery.

“As physicians, we can often get trapped by our assumptions about patients. This can certainly be true when caring for Aboriginal patients, because there is general ignorance about Aboriginal culture, but also a long history that can cause Aboriginals to mistrust doctors,” said Pennington, who is also a general surgeon at Scarborough Hospital.

Pennington is working with Lisa Richardson as the Faculty’s curricular co-leads in indigenous health education to find meaningful ways to address the gap between medical professionals and their Aboriginal patients.

The newly formed Office of Indigenous Medical Education supports Aboriginals applying to the Faculty of Medicine and is one example of how the Faculty is encouraging growth of Aboriginal health professionals. U of T Medicine is also graduating more knowledgeable non-Aboriginal practitioners by integrating Aboriginal health issues and concepts into the undergraduate medicine curriculum in the form of lectures, panels, research projects and electives.

One key concept, Pennington explains, is cultural safety, which was first introduced in the doctoral thesis of Maori nurse Irihapeti Ramsden in 1990.

Cultural safety encourages health care workers to move beyond cultural sensitivity and competence, to consider imbalances in society and to reflect on one’s own biases.

One of the leading proponents of cultural safety is Chandrakant Shah, a Professor Emeritus in the Dalla Lana School of Public Health.

“The key is empathizing with the patient and

understanding their perspective,” said Shah, who is also Program Director of the Cultural Safety Initiative at Anishnawbe Health Toronto where he works as a staff physician.

“This creates a foundation of trust between the patient and caregiver, which can improve health outcomes by ensuring a more realistic treatment plan and a greater likelihood the patient will adhere to it.”

The Cultural Safety Initiative, which Shah has developed and is supported by grants from the Trillium Foundation and Ontario Ministry of Training, Colleges and Universities, is trying to bring these lessons into university and college classrooms throughout Ontario.

Shah has trained a team of 35 Aboriginal volunteer instructors to deliver free talks on the impact of colonial and post-colonial policies on social determinants of Aboriginal peoples’ health, their health status and Aboriginal concepts of health and healing. For more information, visit the Anishnawbe Health Toronto website.

Cultural safety, explains Pennington, is important not only to Aboriginal communities, but to all marginalized communities who may face diminished care because of the biases of their health care providers.

— LIAM MITCHELL Fall 2013 — 17

GLOBAL HEALTH

As a member of AMPATH* — U of T Medicine is improving health for women in Kenya

*Academic Model

Providing Access to Healthcare

Delivering Better Maternal Health in Kenya

18 — U of T Medicine

CHILD AND MATERNAL HEALTH

WHEN PREGNANT WOMEN IN TORONTO think about labour and delivery, many consider whether or not to have an epidural, use a midwife or know the sex of the baby.

But in Eldoret, Kenya, women often give birth without prenatal or neonatal care and choice is trumped by chance, scarce resources and a high rate of maternal death. In Kenya, less than half of births happen in a health care facility. The majority occur at home or in a non-hospital setting without doctors, midwives or nurses.

This dismal picture is brightening, however, thanks to an international partnership that began in 2007 between U of T’s Department of Obstetrics and Gynaecology and Moi University and Moi Teaching & Referral Hospital, both in Eldoret, Kenya. As the lead North American member of the reproductive health component of AMPATH (Academic Model Providing Access to Healthcare), U of T faculty are leading groundbreaking initiatives that are transforming maternal and neonatal care in Kenya.

The goal is to help create a new culture in medicine that’s evidence based, patient-centred and grounded in a multidisciplinary approach.

“It’s something we’ve been able to share by example, so there’s less of a hierarchal approach and one that’s more team-based,” said Professor Alan Bocking, former Chair of the Department of Obstetrics and

Gynaecology.

In fact, some significant changes involve tweaking the medical mindset rather than adding resources. For example, a U of T–led training course for emergency obstetrical and neonatal care staff decreased postpartum hemorrhage by 30 per cent, and significantly increased the use of oxytocin (a widely available (OPPOSITE) “See one, get one, teach one.”

Community health workers receive training while getting access to family planning services supported by AMPATH. (TOP) Justus Elung’at, Project Coordinator, and Astrid Christoffersen-Deb, AMPATH Field Director, travelling to a remote pregnancy club that integrates health education, savings and loan programs.

(FAR LEFT) Dr. Philip Tonui, an obstetriciangynecologist at Moi Teaching & Referral Hospital, teaching emergency obstetric care to rural providers.

(LEFT) Members of Chama cha MamaToto, a pregnancy club that integrates health education, savings and loan programs, open a box where banking materials are stored.

PHOTOS COURTESY OF ASTRID CHRISTOFFERSEN-DEB

Fall 2013 — 19

GLOBAL HEALTH

BONUS: PHOTOS uoft.me/medmag

drug for decreasing bleeding not routinely used in Kenya) from 47 per cent to 92 per cent, one year after the training.

Rachel Spitzer, Assistant Professor in the Department of Obstetrics and Gynaecology, suggests the spike in oxytocin use reflects “a shift in knowledge, education and the culture of care where they now understand the relevance of the intervention.”

Another coup has been setting up community-based interventions in areas surrounding Eldoret to improve accountability and quality in care delivery to women and their children.

“Getting women to come to a facility to have their babies has been a huge

“But what is the point of a screening program if you find cancer and you’re not going to do anything about it?” challenge for a variety of reasons,” said Bocking. “Through communitybased interventions we’ve increased the number of women in rural regions who deliver in a health care facility from 40 to over 90 per cent.”

Astrid Christoffersen-Deb, Assistant Professor in the Department of Obstetrics and Gynaecology and AMPATH’s field director for reproductive medicine, Louis Fazen, Yale University MD-PhD student and their team are leading such outreach initiatives.

“Pregnant women in one district have participated in an integrated savings, loan and health education program. In another, five facilities have introduced a group care approach for pre- and postnatal care. Ninety community health workers now use 20 — U of T Medicine

Android phones to do home-based assessments for pregnant women and infants,” said Christoffersen-Deb, who received funding from Grand Challenges Canada Rising Stars. Her team is hoping to scale up the program with additional funding next year.

Cervical cancer screening and clinical care has been another boon to maternal health in Kenya, with U of T and AMPATH establishing a strong program in 2008. Cervical cancer in Kenya kills more women than any other cancer and affects relatively young women.

“Previously, screening and intervention were not offered, so women would develop more advanced disease and die,” said Barry Rosen, Professor in the Department of Obstetrics and Gynaecology. Rosen led a collaborative team that introduced cervical cancer screening in Kenya, which began with a small study of 150 women and now screens upwards of 15,000 women every year.

“But what is the point of a screening program if you find cancer and you’re not going to do anything about it?” asked Rosen, also Director of the Familial Ovarian Cancer Clinic and Head of Gynecologic Oncology at Princess Margaret Hospital.

That question seeded the idea of establishing a two-year master’s training program at Moi University for gynecologic oncology.

“Through the screening program, they started detecting early cancers — something they had never seen before or been trained to deal with,” said Rosen.

The first two Kenyan gynecologists enrolled in the program have completed their first year. They can perform radical hysterectomies to treat early cancers and have

Mathew Oluoch outside Princess Margaret Hospital

performed 80 operations so far.

The program also introduced chemotherapy to eliminate symptoms in more advanced cases and to shrink tumours down to an operable size in others. So far, more than 200 women have received chemotherapy.

Another way that U of T is modeling care in Kenya is by inviting senior medical students from Moi University to Toronto for an elective course.

“These students are here to witness our patient-centred and evidencebased approach to care,” said Bocking, noting that one of the goals is to stimulate interest in the obstetrics and gynecology specialty. The standard of care they witness will translate into lessons for providing better maternal care back in Kenya.

Mathew Oluoch, a Kenyan medical student, says the most shocking moment from his visit to Toronto was seeing a man (the expectant father) in the operating room as a woman was undergoing a C-section.

“Encouraging men in Kenya to accompany their wives to the hospital is a small change that can make a big difference,” he said.

Oluoch’s epiphany reflects the change that is slowly unfolding in Kenya’s health care system and U of T faculty are helping with that transformation. — ANGELA PIRISI PHOTO: ERIN HOWE

CAMPAIGN SPOTLIGHT

BONUS: PHOTOS uoft.me/medmag

From Concrete Jungle to Kalahari Desert How donor support is helping a fourth-year medical student pursue global education EARLY ONE MORNING AT A PERUVIAN hospital, doctors, nurses, volunteers and patients gather to sing a cheerful tune. Following the song, the bustling clinic begins. Fourth-year U of T medical student Stephanie Dreckmann was one of the voices.

“It was beautiful to see people come together with such emotion and consideration for one another,” she said.

With global health experiences in Costa Rica, Peru and Nicaragua under her belt, Dreckmann is preparing for her first trip as the inaugural recipient of the Greg Wilkins-Barrick Chair Medical Student Scholarship in International Surgery.

In February 2014, Dreckmann will embark on a seven-week research project in Gaborone, Botswana, to work with surgeons at Princess Marina Hospital to develop surgical training programs that better serve the community.

Professor Mark Bernstein (B.Sc. ’72, M.Sc. ’03) in the Department of Surgery was awarded the inaugural Greg Wilkins-Barrick Chair in International Surgery in 2011 and he has subsequently allocated funds from his endowment to various international surgery initiatives and student awards.

“My goal is to do as much good as I can to help the less fortunate and acculturate the future generation of surgeons to carry on this work,” said Bernstein.

“By addressing global inequities in health care, U of T is building relationships that will advance our ability to fight disease throughout the world and here at home.”

Dreckmann says her perspective has changed since her first overseas experience.

“At first I wanted to help improve access to care in developing countries, which is still true, but the people I met have inspired a holistic approach to care that I hope to one day bring to my patients.” — VERONIKA BRYSKIEWICZ

Stephanie Dreckmann (TOP); Mark Bernstein (ABOVE).

Fall 2013 — 21

22 — U of T Medicine

GLOBAL HEALTH

On September 23, 2013, a historic meeting took place at the United Nations: world leaders held their first-ever meeting to discuss how people with disabilities can contribute more fully to their communities and to the global economy. There are more than a billion people with disabilities worldwide and more than 80 per cent are living in resource-poor countries.

PHOTO: RAJ GRAINGER

Fall 2013 — 23

GLOBAL HEALTH

U.S. SECRETARY OF STATE JOHN KERRY rehabilitation sciences sector. Formal addressed the audience. So did partnerships in nine countries, and musical celebrity Stevie Wonder. informal relationships in many others, However, it was a report of a study ensure that academic research at

by U of T’s International Centre U of T can be used to tackle real-life for Disability and Rehabilitation challenges facing people with (ICDR) that ensured the experiences disabilities. of children living with disability in developing countries would be known “Many people would not and felt.

ICDR worked with child rights even seek treatment organization Plan International to because the stigma of their study the experiences of children disability was so great.” in Guinea, Sierra Leone, Niger and Togo. One child — a 12-year-old from Guinea — described his life this way: In Zambia, for example, Nixon “I very much want to go to school, but is working with HIV-positive my friends make fun of me and say patients with disabilities. People that I am incomplete. It is for this very with disabilities were traditionally reason that my dad made me leave excluded from HIV education school.” programs, Nixon explains, because The report, called “Outside the authorities assumed they were not Circle,” showed how children with sexually active. However, they are at disabilities in West Africa face least as much at risk as those without widespread poverty, discrimination, disabilities. violence and exclusion, including from “Many people would not even seek education. treatment because the stigma [of “U of T research on children with their disability] was so great,” she disabilities is bringing information, said. “The barrier to treatment is often context and first-hand stories to the stigma of the disability, more the attention of UN officials,” said than HIV.” Stephanie Nixon (M.Sc. ’00, PhD ’06), This is a new field of discovery — Director and Co-Founder of ICDR. people with HIV had previously been “It builds on experience we’ve gained dying, but anti-retroviral therapies working with partners in Africa, and are now prolonging lives. Some all over the world, to ensure that HIV-positive people have pre-existing people with disabilities, particularly disabilities. They might also develop children, have access to education and conditions, such as arthritis, as a protection from violence and abuse,” result of their treatments. Nixon is said Nixon, an Assistant Professor in leading a study of 35 individuals the Department of Physical Therapy who report on their quality of life at and the Dalla Lana School of Public three- or four-month intervals over Health. the course of their treatments.

It’s a challenge that the U of T Nixon’s research introduces academic community has been an alternative approach called addressing through the leadership “intersectionality.” This approach of ICDR. Formed in 2004, the Centre challenges the assumption is located within the Faculty’s that patients with different life 24 — U of T Medicine

circumstances who suffer from a certain combination of challenges all have the same experience and can be treated similarly.

“Other aspects of people’s lives — ethnicity, sex, sexual orientation, income and so on — may result in very different experiences,” she said. “The focus of rehab is whatever matters to the patient — reducing pain to sleep through the night, being able to pick up grandkids, getting back to work, returning to gardening — or whatever else is important to the patient.”

ADDRESSING THE UNIQUE NEEDS OF each person with a disability also means engaging more partners. That’s been the focus of much of Lynn Cockburn’s (B.Sc. ’86, M.Ed. ’96) work in Cameroon. An Assistant Professor in the Department of Occupational Science and Occupational Therapy, Cockburn has helped establish the Centre for Inclusion Studies in Cameroon. The Centre has developed a number of programs aimed at getting information into the hands of people who can make positive change happen in the lives of disabled people, such as government policy makers, community groups, non-governmental organizations and health care providers.

She’s seen numerous examples of how knowledge translation helps people use research findings to provide better service to people with disabilities.

“Volunteer Services Overseas and Plan Cameroon are putting more emphasis on disability-related issues. More non-government and governmental organizations are showing interest and including disability issues in their activities and plans,” said Cockburn.

It’s all part of an effort to expand,

CARE EQUITY

Stephanie Nixon, Lynn Cockburn and Darcy Fehlings

BONUS: STORY & PHOTOS uoft.me/medmag

INTERSECTIONALITY The study of relationships between different disenfranchised groups or groups of minorities in which researchers examine how gender, race, class, ability, sexual orientation, species, etc. interact simultaneously, contributing to systematic injustice and social inequality.

improve and inform Cameroon’s national conversation on addressing the needs of people with disabilities, support their strengths and improve opportunities for social participation and inclusion. To support that effort, there’s now an annual gathering, the Bamenda Conference on Disability and Rehabilitation, which attracts up to 200 people. It’s organized in collaboration with disability groups and supported by ICDR’s Cameroon group. Doctors and other health care workers join people with disabilities to exchange information, experiences and ideas.

“There were very few mechanisms for information sharing,” said Cockburn. “Now, the conference gives people a chance to present their work professionally. One doctor said he’d never had the opportunity to just sit in a room and listen to people with disabilities talk about their experience.

It allowed him to start seeing the person beyond the patient.”

Cockburn engages U of T students in her work and believes the experience leads to a greater understanding of international settings.

“Students who have experience in these kinds of low-resource settings are carving out a role in a place where occupational therapy is unknown. It helps solidify their knowledge and understand what it means to work with marginalized communities,” she said.

One of those helped by U of T students is Andrew, who injured his spinal cord in a traffic accident.

Unable to return to his previous job, he wanted to become a cane weaver, but couldn’t do the work from a seated position, as is the tradition.

U of T occupational therapy students built him a standing frame that both supported him and raised his work to

the proper height, allowing Andrew to return to the workforce.

THERE ARE EXAMPLES OF HOPE HERE in Toronto too. At Holland Bloorview Kids Rehabilitation Hospital, Canada’s largest children’s rehabilitation hospital, U of T faculty pioneer treatments, technologies, therapies and real-world programs that give children with disabilities the tools to participate fully in life.

Exergames is one of the latest applied-research projects targeted at children with disabilities. It combines exercise bikes and virtual video games to motivate kids with cerebral palsy (CP) to exercise while gaming.

“Using virtual gaming to motivate kids and teens with CP is a great new application of the science,” said Darcy Fehlings (MD ’83), Associate Professor in the Department of Paediatrics who co-led the project with Nick Graham, a computer scientist from Queen’s University.

Fehlings targets teens because the early teenage years are a pivotal time when youth with CP commonly experience loss of function due, in part, to poor physical fitness.

“I think the future is bright for children with disabilities because of exciting new advances in rehabilitation paired with a willingness of clinicians and researchers to collaborate with children and their families to establish common goals for discovery and innovation.”

Whether it’s by helping someone sleep through the night, changing policy or using video games to promote exercise, U of T is leading innovative solutions to help children around the world with disabilities thrive. — JIM COWAN Fall 2013 — 25

GLOBAL HEALTH

26 — U of T Medicine

Q&A

Q&A with Sheila Wijayasinghe Interviewed by Suniya Kukaswadia

On the Road to Health

How a mobile health unit is breaking down barriers for immigrant women

SHEILA WIJAYASINGHE BEGAN A career in medicine with dreams of supporting humanitarian health efforts abroad. But after working on three continents, she realized she could make a lasting impact on global health in her own community.

Wijayasinghe is helping improve access to health care as medical director of Toronto’s non-profit Immigrant Women’s Health Centre (IWHC) and Lecturer in the Department of Family and Community Medicine. Through the IWHC’s mobile health unit, an on-the-go clinic that provides sexual and reproductive services across the GTA, she’s taking medicine to the streets.

Wijayasinghe — whose parents struggled to get the health care they needed when they first came to Canada — shared her insights on women’s health with U of T Medicine magazine.

PHOTO: JACKLYN ATLAS

SUNIYA KUKASWADIA: What are some of the barriers to health that immigrant women face?

SHEILA WIJAYASINGHE: Immigrant women come to Canada with the hope of starting a new life, but often they face many struggles related to language barriers, difficulty finding employment, financial stress and lack of social support. All of these factors can cause a great deal of stress and impact their health in many ways. On top of this, they often are the primary caregivers for their children and have limited time to seek out care for themselves when needed.

Struggling to secure safe housing and food for their families, it’s understandable how their own health can become a lower priority.

SK: Are things improving over time?

SW: Yes, but there is still work to be done. There was a time when doctors felt it wasn’t their role to address the financial and social well-being of patients. Now, we know that our patient’s environments, what they eat, where they live and how safe they feel are all factors that impact treatment.

We can prescribe all the medication and therapies we have access to, but patients won’t get better if we aren’t addressing the social barriers they face. This is why medical students are taught to ask questions about their patients’ finances during routine exams.

SK: How is the mobile health unit addressing these issues?

SW: It’s important to make it easy for patients to get the care they need. We visit workplaces, schools and shelters so that they don’t have to worry about childcare, transportation or time off from work.

We offer sexual and reproductive health services in nine different languages. Our patients can get testing and treatment for sexually transmitted infections, counselling on birth control and abortions as well as cervical cancer screening. We refer patients to other clinics and services if needed. We do not ask for health insurance or identification of any sort and if they do not have OHIP, we do not ask for any payment for services.

The mobile unit is a place of community and acceptance. We have music, food and activities, and our patients often come with friends and relatives. There’s a real sense of togetherness and ease that helps reduce the stigma around sexual health.

SK: What do you like best about the work you do?

SW: Sexual and reproductive health is my passion, and it’s incredibly rewarding to see patients comfortably getting the support and care they need. Working in Toronto allows me to drive long-term changes in the city I call home.

Fall 2013 — 27

ALUMNI PROFILE

From Books to the Balkans How a decorated Surgeon General represents U of T Medicine in the Canadian Forces FEW PEOPLE HAVE SERVED NEARLY four decades in the Canadian Armed Forces. Fewer of these are doctors. Fewer still are women.

And only one of these — U of T Medicine graduate Hilary F. Jaeger (MD ’86) — has retired with the rank of Brigadier General after serving as Surgeon General of the Canadian Forces.

Earlier this year, Jaeger closed out her military career after 37 years of stellar service, littered with achievements and firsts.

Jaeger joined a reserve unit in Nova Scotia at the age of 17 while working towards a bachelor of science degree in mathematics at Acadia University, where she also graduated at the top of the engineering program. She went on to study aerospace engineering at Iowa State University, later enrolling in U of T’s Faculty of Medicine.

28 — U of T Medicine

BOOKSHELF

“I received a first-rate medical education at U of T that fostered critical inquiry and gradually built a balance of confidence and humility that has stood me in good stead when judgment calls had to be made,” said Jaeger. “Whether that was looking after a Crohn’s disease patient in the Northwest Territories, triaging the victims of mortar fire in Sarajevo or assessing the standard of health care available to Canadian Forces members outside Canada, my education supported me along the way.”

Jaeger was deployed to Sarajevo in 1992 as the Senior Medical Officer and the Officer Commanding the National Support Element. In 1994 she returned to the Balkans to command the Forward Surgical Team.

In Canada, she became the first woman and, so far, the only medical officer assigned to teach at the Canadian Land Forces Command and Staff College.

In 2004, she was promoted to Brigadier General and appointed Surgeon General of the Canadian Forces — a job she held for five years.

Then, Jaeger was seconded to Veterans Affairs Canada, where she promoted evidence-based practices in the management of military service-related health problems and disabilities.

From teenage Private in a reserve infantry unit, to army doctor, to Surgeon General of the Canadian Forces, Jaeger’s service is an inspiration for her fellow soldiers.

On the Bookshelf New and noteworthy books from the Faculty of Medicine community. — BY MEERA RAI Partnership for Excellence: Medicine at the University of Toronto and Academic Hospitals Edward Shorter Department of Psychiatry Publisher: University of Toronto Press Partnership for Excellence offers a comprehensive account of the Faculty of Medicine’s history from small provincial school to international powerhouse.

Thoroughly researched through front-line interviews and primary sources, it chronicles the events, breakthroughs and visionary leadership that make the University of Toronto a dominant force in Canadian health care and biomedical research.

Damned Nations: Greed, Guns, Armies & Aid Samantha Nutt Dept. of Family & Community Medicine Publisher: McClelland & Stewart Damned Nations is a critical look at the factors fuelling conflict and instability in low-income nations. Weaving compelling personal stories with fulsome discussion of armed conflict in the world’s most unstable regions, Nutt presents the many threads that bind Western nations to the horrific violence plaguing war-torn countries around the world.

PHOTO: RAJ GRAINGER

OLD SCHOOL

Dr. Norman Bethune (MD ’16) performing surgery in an unused Buddhist temple in central Hopei, China (spring 1939).

PHOTO: COURTESY OF LIBRARY AND ARCHIVES CANADA

Fall 2013 — 29

Calling All Alumni Dalla Lana School of Public Health alumni:

Congratulations!

The Faculty of Medicine would like to extend warm congratulations to our inaugural Faculty of Medicine Dean’s Alumni Award winners:

It’s an exciting time at the Dalla Lana School of Public Health. We would like to make it easy to keep in touch.

DR. HENRY BARNETT DR. DONALD COWAN Lifetime Achievement Faculty of Medicine Award Volunteer Award

UPDATE YOUR CONTACT By e-mail dean.dlsph@utoronto.ca or phone (416) 978-6505.

DR. SAMIR SINHA Rising Star Award

Please visit uoft.me/med-alum-award for more information about these new awards and find out how you can nominate a Faculty of Medicine alumnus.

VISIT THE WEBSITE www.dlsph.utoronto.ca and sign up for the e-Bulletin.

Spring Reunion ’14

VOLUNTEER With the Public Health Alumni Association and help shape the next generation of public health leaders. If you’re interested in joining leadership committees, mentorship programs or the association board, please contact public.health@alumni.utoronto.ca.

SAVE THE DATE FOR THE UNIVERSITY OF TORONTO’S 2014 SPRING Reunion weekend, May 30–31, 2014. Honouring all alumni who graduated in years ending in 4 and 9, the weekend will include lectures, lunches, dinners and drinks. Stay tuned for more information!

Get Involved THE FACULTY OF MEDICINE’S ALUMNI RELATIONS OFFICE IS CURRENTLY recruiting alumni volunteers for various programs, events and projects.

We are looking for speakers, mentors, board members and history buffs.

If you’re interested in any of these opportunities, please contact Morgan Tilley, Alumni Relations Coordinator, at (416) 978-3588 or morgan.tilley@utoronto.ca.

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