UCLA Public Health Magazine - Summer 1982

Summer 1982 Magazine of the UCLA School of Public Health and the UCLA School of Public Health Alumni Association

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Publie Heal~h

A stubborn optbnis1n

UCl.A Publie Health Summer 1982

For schools of public health this is a time of ambiguity. On the on e hand the schools are being asked to reduce their budgets and, on the other, they are being told that improvem ents in the health of th e American people must come from a renewed national commitment to prevent disease and promote health - a charge that is clearly the major mission of a school of public health. Paradoxically, the schools are being asked to do more with less. I'd like to illustrate this paradox with a few examples of how this problem affects the UCLA School of Public H ealth.

We face budget cuts in both state and federal funds. The projected budget reduction for the University of California in the coming year has been estimated to be significantly larger than in the current year. The School, along with all other units in the University, will have to make significant reductions in its budget. Absorbing these cuts, however, is particularly difficult for us as we have been chronically underfunded.

Already efforts to reduce the School's budget this year forced us to lay off eight of the School's regular staff. In the coming year other equally painful actions may also be necessary. At the federal level, support for students through traineeships and loans are threaten ed by current proposals from the President, thereby having a particularly severe impact on public health students.

The paradox stems from the fact that at the same time these cu ts are occurring we are being challenged by requests from the LA County Health Department, the California State Department of Health Services and various representatives from voluntary organizations and private industry to provide information and guidance on ways to promote health, coordinate services and reduce h ealth care costs.

On the positive side, we have an excellent faculty who continue to be successful in obtaining research monies in an increasingly competitive environment. We continue to attract bright, yo ung, committed faculty who are contributing to the field of public health with enthusiasm. We continue to develop new programs that reflect the expanding field of public health.

Times such as these test our resourcefulness. There is a temptation to be engulfed in pessimism and to forget our need to pull together. Yet we must not let this happen. We will need to reevaluate o ur priorities. In particular, we w ill be forced to make qualitative judgements about the types of research to pursue, th e kinds of classes to teach, the programs to support and the way to focus our community service efforts.

We need to be even more sensitive to the many oppor tunities which are increasingly difficult to recognize, but which are there. If we are to prevail in our mission to promote the health of Americans, we must continu e to aggressively seek out these opportunities even in this time of ambiguity. Clearly these times call for a stubborn optimism.

Roger Detels, M .D., M.S., Dean UCLA School of Public Health INSIDE COVER: Refugee mothers learn about nutrition from community health workers in Chad. United Nations/UNICEF photo. See story on refugee health on page 4.

4

Refugee relief: The children are starting to smile again

7 Making the workplace a safe place

8 Charting a course for health services

10 Chinese scholars explore new horizons

12 A tightening net for public health

13 A frank discussion about genital herpes

14 A winning job strategy

16 When you pick up the Times, you pick up Drs. Alfin-Slater and Jelliffe

17

The X's and Y's of genetic counseling

18 Jo Alvarez: Growing with the School

19 News 20 Dean's Council Alumni news

21 Notes Director Health Sciences Communications: Darlene Doriot Editor/Writer: Judi Reich Photography: Terry O'Donnell Faculty consultants: Lawrence R. Ash

Juel M. Janis Alumni coordinator: Barbara Broide Director of Development: Judith C.

Angel

COVER PHOTO: Refugees of all ages are affected by disasters, man-made and natural. On the cover, a Cambodian refugee helps with the feeding of a young child United Nations/ UNICEF photo by John K. Isaac.

Refugee relief: The children are starting to s1nile again Homeless. Frightened. Hungry.

Victims of war, earthquake or drought, thousands of refugees each year are forced into countries and conditions totally foreign to them. Even the volunteers who flock to help these refugees are often amazed at the conditions they find.

Speaking to a spellbound class of public health students, Dr. Davida Coady recounted her first trip to Honduras in April 1981: "I went to an area along the border, where there were 22,000 Salvadoran refugees. It's a very remote area, mountainous and rugged.

There were no latrines at that time and the only water was out of the river. You can imagine with all those people that the water was grossly contaminated. An average of three children were dying each day, mostly from water-borne diseases."

Dr. Coady is one of several UCLA public health professors and students who have worked overseas with refugees. As a result, the School three years ago started the first training course of its kind on refugee health programs. Dr. Derrick Jelliffe, professor and head of the Division of Population, Family and International Health, is the driving force behind the course entitled "Refugee Health Programs, General Principles."

"It is essential to have courses such as this one since there is a lack of people trained to understand the problems of refugees," says Dr. Jelliffe, who notes that more than 12 million refugees are now scattered around the globe as a result of man-made and natural disasters.

Dr. Jelliffe and his wife, E.F. Patrice Jelliffe, a lecturer at the School, wrote an article on refugee medicine which appeared in the January 1981 issue of The Sciences.

In it, the Jelliffes cite examples of 4

A young Salvadoran boy reaps the benefits of the harvest at the refugee camp at La Virtud. By teaching refugees how to produce their own food, relief workers help promote a feeling of self-sufficiency and independence. Photo by Davida Coady. inappropriate assistance administered by well-meaning but illtrained workers.

"A well-trained American or European physician, pediatrician or nurse, without past experience in developing countries and without prior orientation, can be of very limited effectiveness and may even prove a liability in the refugee camps-particularly with shortterm volunteers," they wrote.

"Common clinical problems, such as chloroquine-resistant malaria, protein-energy malnutrition, cholera or intestinal parasites, are virtually unknown to them, and as Western-trained health professionals they are lost without the support of laboratories. " ... In the recent past, the supplies, particularly the foods, have often included the culturally inap-

propriate or even the ridiculous. In Central Africa some 20 years ago, supplies of out-of-date 'Metrecal' and processed chicken tetrazzini arrived at the refugee camps."

Dr. Jelliffe's course stresses resourcefulness, flexibility and creativity. Personal testimony from guest speakers further enhances the content.

Dr. Coady is one of those inspirations. She spends half the year teaching at UCLA in the schools of public health and medicine. The rest of the time, she spends overseas working for CONCERN, an Irish-based international organization which sends people to Third World countries in relief and development programs.

She has spent time in Biafra, Bangladesh, Uganda and on the Thailand/Cambodia border. Most

recently, she made several trips to Honduras on behalf of CONCERN. It is she who can give historical perspective to the progress the refugees from El Salvador were able to make with the assistance of volunteers from CON CERN and from several other international organizations.

Dr. Coady encouraged Carole Clarke to spend four months in Honduras as a part of CONCERN. Clarke, who had worked with Dr. Coady at the Venice Family Clinic, graduated from UCLA in 1980 with a double master's degree in public h ealth and Latin American studies.

In Hondu ras, Clarke worked in an area called La Virtud, or "place of virtue," which, she says, it is not. La Virtud is on the border of Honduras, two kilometers from civil war-torn El Salvador. It is an impoverished town of about 300 which last year experienced an influx of 13,000 Salvadoran refugees.

Instead of rebuking them, the townspeople took 10,000 of those refugees into th eir own homes, built lean-tos onto their houses and shared food. The remaining 3,000 settled in three camps just down the hill from La Virtud. " I realized that the reason they were taking the refugees in was because it's really a Central American process going on," Dr. Coady speculates. "It's not just a Salvadoran revolution, or a G uatemalan revolution, or a Nicaraguan revolution ... it's a Central American revolution and Honduras could be next ... " Clarke arrived in June. She originally planned to work with primary health care workers but found that help was needed with a nutrition program.

"I adjusted myself accordingly," she says. "The first thing I did was some basic data collecting.

No one knew how many refugees there were. The population density was incredibly high; you could step from one tent almost into the n ext in on e or two giant steps. And each of the tents had an average of eighteen people per tent. You're talking about tents

that are 15 by 30 feet, but at an angle. So in most cases there were somewh ere between two and four nuclear families each trying to get thei r little spot within this tent and each trying to make it 'home sweet home.'"

She enlisted Honduran medical students to h elp count the refugees and to classify them into different age groups. Then they began to determine which groups were at risk of malnutrition, particularly concentrating on the lactating and pregnant women, old people and children under the age of seven.

Under Clarke's direction, serial weighing programs were set up for the children. Those in thirddegree malnutrition (the most severe) were weighed once a week, those in second-degree every two weeks and first-degree once a month.

Milk distribution centers were also organized. "If there wasn 't milk, we substituted with soy, and

then we'd substitute down to whatever we could ... and beg for more," Clarke recalls.

When she first arrived, a supplementary feeding center was serving 200 people an extra helping of vegetable soup a day. By the time Clarke left four months later, nearly 700 refugees were receiving extra feedings. The data she h ad collected had h elped h er write a convincing proposal to support groups who then raised the weekly food budget from $250 to $1,000.

"Carole Clarke was CONCERN's first volunteer in Honduras.

UCLA's program really gave her the tools to develop a very excellent program ," Dr. Coady says. "I can't say enough good about what she set up."

By November, the refugees in the camps at La Virtud were in better h ealth.

"Th e h arvest had come in, the kids looked terrific and were starting to smile again. I'm sure they were in better nutritional shape

UCLA graduate student Diane Kuntz consults with a mother and her severely malnourished child at a camp in Honduras. Photo by Davida Coady.

5

than they had ever been in their lives. Parents had been taught a lot about nutrition, and fruits and vegetables had been added to their diets," Dr. Coady observes.

"The refugees built a new nutrition center which was their pride and joy. It was also used for health worker training and as a social center. They have even written a song about the center."

Politically, however, the situation had become worse. Episodes of refugees and workers being taken hostage or killed were reported. Finally, in early 1982, the Honduran government began moving some of the refugees to an area called Mesa Grande. Even though the conditions in Mesa Grande were bleak, Dr. Coady reported that, by March, no deaths had been reported "largely due to the good condition the refugees were in and to the preventive medicine program which had been initiated."

Clarke, who returned to Los Angeles in September, will be moving to Northern California to direct ten migrant Head Start programs.

Other public health students have had firsthand experience working with refugees. Ed Scholl (B.S. '80) and Diane Kuntz, a graduate student in public health and Latin American studies, are currently in Honduras. Some students have gon e to Thailand, India, Bangladesh, Mexico and Uganda.

Sarah Habbane, Dr. Alfred Zerfas and Lynne Arm strong, all either M.P.H. degree candidates or graduates, spent time in Somalia last year with the relief organization Save the Children.

"My interest in refugees started in Dr. Jelliffe's class," says Armstrong, who received her M.P.H. degree in 1981. She remembers listening on the edge of her seat as guest lecturers shared their experiences with h er class. This year, she was one of those speakers.

She told of Somali a's refugee situation which is a result of both war and famine. Approximately 6

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Water, an essential need for refugees, is often hard to obtain as witnessed by this woman in Somalia.

United Nations / UNICEF photo.

one-fourth of all Africa 's refugees are in Somalia, a country the size of Texas. More than 1.5 million have crossed the borders into the country (with an original population of 3.6 million ) seeking refuge from the war between Somalia and Ethiopia over possession of the arid Ogaden Region. Others have becom e refugees in their own country fleein g from famine. An estimated 1.5 million refugees live in 32 camps around the country, and an additional half million live outside the camps.

Armstrong's contribution was to design nutrition education programs. Through an interpreter, she instructed teachers in the camps about nutrition and they would in turn spread the information to the other refugees.

"One of our most interesting classes was on traditions and beliefs. We tried to separate what was fact and what they believed was fact because they had heard it all th eir lives," Armstrong says.

She describes as an example an infant weaning mix she had suggested preparing with some of the rations: "They had rice and beans as part of their ration and we showed them how to make a porridge out of that. To sweeten it, instead of adding sugar, we added mashed bananas.

"But they said they couldn't feed their children that because everyone knows bananas cause worms. So we had a quick discussion about where worms really come from and then we designed a

whole new class on worms."

Sarah Habbane is from Somalia. She and her husband are currently studying at UCLA, he as a Fulbright Scholar and she as a double master's candidate in public health and African studies. When the opportunity arose to help in the camps through Save the Children, she seized the opportunity.

She taught community health workers in thirteen camps about basic sanita tion, how to screen for malnutrition and how to detect certain diseases.

This was not the first time Habbane had worked with her country's refugees. In 1974, severe drought had caused an initial wave of refugees to flee their homes.

The government closed down every secondary school and college in the country and 25,000 students and school children over the age of 16 were trained and sent to the countryside to become tutors for the nomadic families. Habbane was a university student at the time, so sh e spent three months helping with supplementary feeding programs.

Before coming to UCLA, Habbane taught biology and chemistry to high school students. Since she is a government employee, sh e doesnotknowwhathernexta~

signment will be when she returns home but she hopes she can help with the refugees. She says her education at UCLA has given her some insights into what can be accomplished.

"Students in Somalia don't work over the summer sin ce there aren't jobs," she explains. "I've been thinking that there is a lot of unused manpower and resources.

When these students go h ome for the summer, they could do some research about what is available in their particular area of the country, what the needs are, what the diseases are, and what could be done to help."

It is these kinds of thoughts and skills that Dr. Jelliffe hopes to provoke in his students. His refugee h ealth course, combined with the School's curriculum, is a step in the right direction. D

Making the 1Norkplace a safe place Cons truction accidents, black lung disease, exposure to dangerous chemicals ... is the American workplace a disaster waiting to happen ?

Probably not, but there is a health awareness that there are certain situations and toxicants from wh ich workers ca n, and should be, protected.

Awareness is one thing. The Sou thern Occupat ional Health Center (SOHC) is another. Presently on the launchi ng pad, the SOHC is one of two centers in California established by a 1978 law which required the state's Departmen t of Industrial Relation s" ... to cooperate with the University of California to create occupati onal health centers for the purpose of training personnel and performing functions in the field of occupational health and medicin e."

As a result, UCLA and UC Irvine (UCI) joined together to form the southern chapter while the UC campuses at Berk eley, San Francisco and Davis compose the Northern California Occupat ional Health Center.

The first director of the SOHC, Dr. James Whittenberger, came on board on April 1, 1982. H is office is located at UCI, which is the center's homebase. Dr. Jess Kraus, UCLA professor of public h ealth, serves as the associate director.

As its con tribution to the center, UCLA will be providing expertise from the schools of public health, nursing and medicine.

Input from the School of Public Health includes Dr. Kraus in epidemiology; Dr. John Froines, former deputy director of NIOSH, in industrial toxicology and hygiene; and Dr. Michael Vojtecky in occupational health education . Dr. Maryalice Jordan-Marsh leads the program in occupational health nurs ing and Ors. Philip Harbor and Jean Wallace represent the School of Medicine in developing a referral center and clinic for occu-

pational health disorders. For its part, UCI will be enhan cing its toxicology and environmental engineering programs as well as its occupational med ici ne residency program.

"The center will focus on and integrate the expertise of each campus as much as possible," says Dr. Whittenberger.

As the faculty grows, the specifics of the academic program a rc being more fully deve loped to reflect th e strengths of the faculty.

Under consideration is establishing a cross-disciplinary degree, perhaps utilizi ng both the Los Angeles and Irvine campuses. Currently, UCLA public health students arc being offe red classes in occupational health in va rious divisions and next year the first general course on the subject will be offered. Eventually, a M.P.H. degree with an emphasis in occupational health may be offered.

Whatever final form the curriculum takes, there are som e key

issues in occupational heal th today whi ch must be addressed, Dr. Kraus says. First, is the question of what are the responsibilities of government in protecting workers and, secondly, what are the responsibilities of business and industry?

"Further, we have a large unknown area which has to be studied to determine if there a re problems associated with certai n occupations and types of exposures," the associate director says. " In the 1980's, occupational health is going to be a bigger issue than ever before and we have to supply some answers. Right now we have too few people trained to adequately examine the breadth of the questions we have."

Dr. Kraus is optimisti c about the future of the SOHC. He says: "A year from now the degree program sh ould be highly visible, the research posture of its faculty should be prominent ... we should be a fo rce to reckon with." D

Southern Occupational Health Center members {from left front): Mariann e Brown (temporary member, UCLA), Dr. Michael Vo;tecky (UCLA) , DL Maryalice fordan -Marsh (UCLA); Dr. fess Kraus (UC LA); DL fohn Froines (UCLA), DL fam es Whittenberger, director (UGI), DL fan Scherfig (UGI). Back row: Perry Brown (UCLA graduate student); Dr. fean Wallace (UCLA), DL Philip Harbor (UCLA), foan Brown {UGI), Dr. Dwight Culver (UGI) and DL Timothy Crocker (UGI).

7

Charting a course for health services A health care administrator must frequently navigate turbulent political and financial waters. The training and experience necessary for this is provided to future health care leaders by the Division of Health Services in the UCLA School of Public Health.

The division, one of six in the School, is divided into two programs, each offering graduate degrees from the master's to the doctoral level. The Health Services Management component trains students to run institutions and organizations which provide personal h ealth care services-hospitals, mental health, long-term, nursing and ambulatory care facilities. The Planning, Policy and Research portion of the division prepares students to become health planners and policy analysts in both the private and the public sectors.

"We've been bringing the programs closer together sin ce we realize managers, on the one hand, have a heightened need to understand the complexities of h ealth planning and policy development and, at the same time, planners need to understand how health facilities are managed," observes Dr. Stuart Schweitzer, head of the division.

The management program is a small one, accepting sixteen students a year from an applicant pool eight times that size. The intimacy of the program allows personalized attention and assures placement in top-notch residency programs. The students spend one quarter part-time and nine months full-time in an experiential learning situation. Through these residencies, as well as through faculty involvement in the field, the faculty keep informed of the skills required for today's administrators.

"Training has become more analytical than in the past since 8

Drs. Stuart Schweitzer, left, and Dennis Pointer review graphs reflecting national health care expenditures.

administrators must contend with a mix of patients now covered by a multitude of reimbursement plans," notes Dr. Schweitzer. "As a result, we have added more courses on financial analysis and operations research ."

Employment is never a problem for the graduates, according to Dr. Dennis Pointer, director of the management section.

"Because we have a small class and because we have an active alumni group of about 300, we

don't have difficulty finding good jobs for our students," he says, adding that 90 to 95 percent of the graduates work in Southern California.

The program aims to produce management generalists, prepared to adapt to any health care facility in which they are employed.

Those who do seek more specialized training, however, can enroll in one of several intra-campus programs in which the School participates.

The Graduate School of Management and the School of Public Health offer a three-year curriculum which leads to the concurrent award of master's degrees in business administration and public health.

"The M.P.H. part of the program is to find out about the industry to which you are going to apply your skills, and the M.B.A. portion is to develop specialized business skills," Dr. Pointer explains.

The School of Nursing offers a Graduate Program in Nursing Services Administration leading to a master's of nursing degree. Dr. Pointer, co-director of that program, explains that more than half of the courses for this program are taken in the School of Public Health.

The School retains ties to joint degree programs in the School of Medicine. Those enrolled in the preventive medicine residency or clinical scholars programs, for example, are required to take courses in the School and receive master's degrees in public health.

In addition, a unique one-year M.P.H. program encourages physicians, lawyers and dentists to apply health administration to their specialties. Dr. Paul Torrens, a professor in the division, began this program three years ago and has been pleased with the response.

He's accepted fifteen professionals to the program each year.

"We've been able to attract professionals back to school to 'capture' them for public h ealth,11 he says. "It's important to train these people who already have advanced degrees because they will probably end up in positions of influence."

The largest number of students in the Division of Health Services-fifty a year-are enrolled in the second component of the division, the Planning, Policy and Research program, directed by Dr. Schweitzer. By learning statistical methodology, data handling, economic interpretation, and public policy development and analysis, these students learn to

plan future programs of health services for various population groups. They also engage in a tenweek internship to gain practical experience.

Graduates of this program h ave traditionally sought employment in the governmental sector.

Current Reagan Administration policies, however have caused cutbacks in many of these jobs.

At the helm Full-time faculty in the Division of Health Services are involved in a variety of re· search projects pertaining to the field.

Following is a sample of their current interests: Lester Breslow, M.D., M.P.H., professor and dean emerit us of the Schoo l of Public Hea lth, is active in numerous state, na· ti onal and international organ izations. He is currently involved in stud ies pertaining to health measurement, health policies and the epidemiology and prevention of chronic diseases.

Robert Brook, M.D., Sc.D., professor, is invcstigating the effect of different hea lth in· surance plans on health status and quality of care. In addition, he is studying how technology is disseminated among physicians, and is attempting to measure the quality of care in ambulatory setti ngs.

James Cameron, M.P.A., Ph.D., assistant professor, is primarily interested in policies of health care reimbursement and mental health. He is working on projects involving alternative approaches to hospital and long· term care reimbursement policies.

Joseph Coyne, Ph.D., assistant professor, is interested in the performance of mult i- in· stitutional organizations and serves as a technical advisor to several national health care organizations.

Jonathan Fielding, M.D., M.P.H., professor, is involved primarily in di sease prevention and health promotion research and program development. He is designing and testing a curricu lum to prevent s moking and al· coholism among teenagers; analyzing data from the risk reductio n residential program of the UCLA Center for Health Enhance· ment; conducting a controlled trial of the effect of an intensive lifestyle change pro· gram on Medi-Cal recipients; and developing two large-scale health enhance· mcnt programs in locally based corporations.

Dennis Pointer, Ph.D., professor, is director of the Program in Hea lth Services Manage· ment, is associate director of the UCLA Hospital s and Clinics and is a professor of psychiatry, UCLA School of Medicine. He is interested in the application of be· havioral science theory and techniques to increase organizational effecti veness and has recently designed a self-evaluation process that can be employed by executive teams and task groups.

Milton Roemer, M.D., M.P.H., professor, is involved in studies for the World Health

"The best thing we can do is to train people with the h ighest level of competency and skill possible which will let them function in any sort of political climate," Dr. Schweitzer says. "For example, the Administration has proposed the eventual elimination of comprehensive health planning at the local level. Many of our students have been employed by local plan-

Organiza tio n on national health care sys· terns in developing countries.

Ruth Roemer, J.D., adjunct professor and researcher, specializes in the legal aspects of organized health services. She is cur· rently completing a two-year study with Dr. William Shonick on the private man· agement of California county hospitals.

Martin Ross, Dr.P.H., assistant professor, is interested in the applica tion of manage· mcnt and organization theory to the design and management of health services organi· zations. He recently developed a method for assessing the management development needs of mid-level managers in hospitals and is actively involved in developing pro· grams for meeting those requirements.

Stuart Schweitzer, Ph.D., professor and head of the Division of Health Services, is an economist whose principal interest is health policy analysis. His research ac· ti vi ties include assessments of health care technology; health personnel requirements; economic aspects of care for the elderly; and the economic burden of smoking and alcohol abuse. He recently served in Washington, D.C. on the senior staff of the President's Commission for a National Agenda for the Eighties.

William Shonick, Ph.D., professor, has been invol ved in research on health ca re in the public sector. Specific stud ies have in· el uded mergers between public hospitals and public health departments, and the use of private management to manage public hospitals in Calfornia.

Paul Torrens, M.D., M.P.H., professor, has been investigating the role of the private sector in relation to the National Health Service in England. He's also studying hos· pita! programs in the United States, par· ticularly the problems related to thei r organ ization and financing. Dr. Torrens is interested in the organization of care for pa· tients in nursing homes, and has worked on several projects that explore the current status of public health activities by local government in California. He's also in· volved in an international study of the role of the physician administrat0r in the or· ganization of heal th care in various cou ntries.

In addition to these full-time faculty mem· hers, part-time faculty with joint appoint· ments in other campus departments fu rther enhance the Division of Health Services.

9

ning agencies. If the Administration's proposals are adopted, those jobs will disappear. Yet, planning will become even more important and decentralized becau se it will have to be done by virtually every provider."

Faculty in the Division of Health Services are personally involved in an array of activities at the local, state, national and international levels. To keep a finger on the pulse of the industry, they are continuously involved and contributing to the direction of research and policy implementation (see accompanying article) .

For example, Dr. Ellen Alkon, professor, is also the chief public health physician for the Western area of the Los Angeles County Department of Health Services.

She teaches a course in the division on the organization and management of local governmental health departments. The Western area, in turn, becom es a "clinical laboratory" for students who participate in special projects.

"Our greatest strength is the quality of the faculty and their direct involvement in the practice of health services," Dr. Schweitzer sums up. " Our management faculty is directly involved in working with hospitals and institutional providers. The planning and policy analysis faculty is involved in public and private agencies and organizations. In other words, there is a recognition that our faculty are leaders in the field ." 0

10

Chinese scholars explore ne1N horizons

Drs. Ho Lien-yin, left, and Wang Tian-gen pursue th eir studies in the UCLA Biomedical Library.

Scientific research in China virtually ground to a standstill for a decade during and following the Cultural Revolution. But when China reopened its frontiers to Western ideas five years ago, its scientists began to update their knowledge by studying abroad.

UCLA currently hosts 120 Chinese scholars, four of whom are studying in the School of Public Health. The Chinese government and UCLA are sponsoring the four men during their varying length s of stay here. Each left a wife and family in China to pursue scientific knowledge to bring back to their homeland.

Dr. Ho Lien-yin is at UCLA for six months to study parasitology with Dr. Larry Ash, UCLA professor and chairman of the School of Public H ealth . The two first met in 1978 when the American Society of Tropical Medicine and

Hygiene D elegation visited China.

Dr. Ho is typical of public health professionals in China, most of whom have medical backgrounds.

He graduated from Beijing Medical College in 1949, and is currently an adjunct professor of medicine there. In addition, he is a vice research m ember of the Beijing Tropical Medicine Research Institute.

At UCLA, Dr. Ho attends Dr. Ash's course on helminthic diseases and is undertaking several research projects. He's learning how to use the scanning electron microscope to better understand the morphology of parasites, and is developing tissue culture procedures for a human parasite he brought with him from China.

Dr. Wang Tian-gen is a friend of Dr. Ho's, and they and their spouses were all classmates in medical school. At UCLA, Dr. Wang is studying in the Division of

Epidemiology for a year. He is on leave from his positions of associa te professor of epidemiology at Beijing Medical College and deputy director of the Epidemiology Department at the Beijing Cancer Research Institute.

"My main interest is in cancer epidemiology since cancer h as become the main cause of death in China," he says, adding that stomach cancer is the most prevalent form.

Two other visitors from China, Zhao Yi-zhang and Chien Tse-Shu, are studying the production of methane gas (or biogas) which is created through the fermentation of crop and animal wastes. They are learning from UCLA professor Dr. Robert Mah and his research assistant, Dr. Ida Yu. Drs. Mah and Yu have been isolating methane-producing bacteria in their laboratory and feel their techniques can help the Chinese, who are leaders in the use of biogas to produce energy.

There are currently seven million biogas generators through the Chinese countryside.

"Our government feels biogas generators are an effective way to solve the en ergy shortage in our rural areas," Chien says. "In our country, 800 million people live in the countryside (out of a population of 1 billion). Our government hopes to develop the generators so that in ten to twenty years every household will have one as an en ergy source."

Chien, an associate professor of soil microbiology at the Chekiang Agricultural University, is studying the microbiology of bacteria to learn how to increase gas production in the generators.

Zhao, a research associate at the Chengdu Institute of Biology, says: "The leader of our institute sent me to America to learn how to enrich bacteria and how to get pure cultures." Zhao will be here for two years learning about the microbiology physiology of anaerobic bacteria.

The two men knew each other in China since they are in the

same field, although they live in different provinces. Here they ¡share an apartment near the university.

Chien plans to set up a laboratory identical to Dr. Mah's at his university in China. The Chinese government has given him money to purchase equipment in the United States to bring back home.

"I'm learning a lot about biogas," h e says. "Before I came h ere I took a sample from the countryside digesters. From this sample, I've isolated two bacteria which can produce a large amount of biogas so I will take this information back to China ."

Direction in research is not the only h elp the sch olars have re-

Most of their time is spen t at the School or trying to improve their English. The UCLA China Exchange program on campus offers courses in English and sponsors social and cultural gatherings for the visitors.

Learning seems to be top priority in the minds of the four scientists. They a re grateful for the opportunity to study at UCLA but remain sensitive to the different public health concerns of their country. The main health issues in China are infectious diseases and industrial h eal th.

"In our country, the laboring people are first and we must take care of all of them," Dr. Wang says.

Population control is another

Z h ao Yi-zhang, right, and Chien Tse-shu measure methane production. ceived from their UCLA hosts. Dr. Yu accompanied Chien and Zhao on their first trip to the supermarket, a foreign yet exciting experience for the visitors. Drs. Wang and Ho chuckle when describing their introduction to the American Christmas and New Year's festivities.

"During your holiday season we were very busy socially ... many professors invited us to their parties," Dr. Ho said . "In China we just have the Chinese New Year, now called the Spring Festival. But your holiday is so long. We rea lly enjoyed it!"

They have all ventured to Disneyland, Hollywood and Chinatown, but not much further.

key concern and a strict national policy has been structured in recent years. According to Drs. Wang and Ho, married couples are encouraged to have only one child.

Those who have more offspring suffer economic and medical sanctions. Further, there are restrictions setting the minimum ages of men and women at marriage.

Medical costs are much lower in China, Dr. Ho says. "When we see a doctor we pay the equivalent of five or ten cents for any kind of doctor, from the very famous physician on down," he points out.

"The government pays doctors.

They are common civil servants on a salary." D 11

A tightening net for public 1nedicine

by Gabrielle Hammitt Like so many things, it's mainly a question of money. Public h ospitals don't have enough of it, and the way our health care system is currently set up, they aren 't likely to get any more. This leaves public hospitals, in Dr. E. Richard Brown's words, "in deep trouble."

Dr. Brown, assistant professor of public health, has been studying the problems facing publicly delivered health care for the poor.

His studies have convinced him that the basic funding structure of health care delivery has placed public hospitals in a disastrous fiscal position, and that this in tum continues to narrow the access low-income people have to medical care.

"Public hospitals serve a population which is left over and rejected by the private sector," he says. Such groups, he explains, include undocumented immigrants, the unemployed, Medicare and Medi-Cal recipients and the working poor, who earn too much to qualify for government assistance, but too little to buy adequate health insurance.

Although many nonprofit hospitals serve these patients, the great majority of the patients, particularly those without any third-party coverage, turn to public hospitals for health care. The result? Public hospitals are caught in a tightening net of high expenses, low revenues and little government help in sight . In fact, says Dr. Brown, "the high net cost of public medical care has made public hospitals obvious targets for local officials looking for ways to cut the costs of government."

His monograph on the subject, "Public Medicine in Crisis: Public Hospi ta ls in California," was published in February by the University of California's Institute of Governmental Studies, for the 12

Rick Brown contemplates the plight of public hospitals.

California Policy Seminar. The latter, a joint undertaking of university faculty and the state legislature, seeks to identify and analyze issues that are important to Californians. Clearly the future of health care delivery is one of those issues.

"There is a great and growing interest in these problems, largely because of the current administration in Washington and the economic situation," says Dr. Brown.

"Fiscal crisis at the state and federal levels has created tremendous pressure on counties, which operate California's thirty-seven public hospitals. As costs go up and funding doesn 't, you've got a problem."

More accurately, poor and underinsured patients have the problem. Some 800 public hospitals in this country are in danger, many on the brink of bankruptcy

or targeted for closure. Most exist primarily to serve the poor.

"For many of these people, there just is no other care available," Dr. Brown says. " If those hospitals bite the dust . .. " He shrugs, his meaning clear.

With the n eed so great, why hasn't financial help been forthcoming? He explains that there are a number of myths about public hospitals which are not easily overcome.

First, it is generally believed that the quality of care is low.

That's false, asserts Dr. Brown. He has found that patient care is "relatively good," and that it is merely the atmosphere and accommodations of public hospitals which are less luxurious than many private facilities.

Second, h e lists the belief that public hospitals cost more.

"That's false too," he says firmly. " I reviewed the literature, and if you compare apples with apples, you find that public hospitals cost somewhat less, on the average, than private hospitals."

Too often, he concludes, public hospitals appear to be inefficient, when there is no real evidence that they are. Instead, " they are facing very difficult market conditions without the revenue resources available to private hospitals. " If public hospitals are allowed to close and local governments fulfill their responsibilities to the poor through contracts with private hospitals, that will ultimately cost more than maintaining public health care, Dr. Brown claims.

"I personally believe that health care delivery would best serve the needs of everyone if it was organized as a National Health Service," he says. "I think it can be decentralized and democratically run to meet local, state and national needs. And I view the existing public health care system as the foundation for that, so natu-

rally I would not like to see it disappear."

In his report, Dr. Brown calls for greater attention to the impact of widespread public hospital closures, and for more research into their financing, political support, management and fun ctions.

"Public hospitals need to serve a cross-section of the population and avoid the stigma of being 'houses of poor medicine,' " he asserts. "In order to mak e that possible, we need an insurance system that is universal and that covers our entire population adequately."

Options Dr. Brown outlines for the future of public hospitals include: closin g them and arranging with private providers for alternative medical care, which he cautions may not guarantee an adequate level of care; maintaining them in their present role, which demands more effective organization; or transforming public hospitals into true community hospitals, a controversial step likely to bring opposition from private facilities, along with the n eed for large injections of capital.

His own research, which began with a proposed evaluation study of the closure of Santa Barbara General Hospital in 1979, n ow focuses on two related issues: the development of precise methods to assess the results of public h ospitals closing in specific areas, and an assessment of the effectiven ess of state laws and community organizations in protecting the access of low-income citizens to medical services. The $50,000 grant Dr. Brown received from the California Policy Seminar led to two additional grants in these areas. 0

'

j

A frank discussion about genital herpes Sexual promiscuity during the last decade has contributed to the n ation's current epidemic of genital h erpes, according to a panel of experts. But the "free love" generation has been anything but open to discussion about the disease.

Also known as the " Silent Epidemic," herpes has been a hushed subj ect as a result of the image historically associated with venereal disease. It has been thought of as an unsanitary condition restricted to lower classes.

Gabrielle Hammitt is a public informa tion representative for the UCLA Center for the Health Sciences.

Figure 1 shows a n ormal kidney cell culture, while figure 4 dem onstrates the effect of the herpes simplex virus.

Over the last ten years, however, middle and upper class Americans h ave joined the ranks of the estimated 500,000 new cases cont racted each year.

A panel of specialists brought the topic to the forefront during a public lecture in January, sponsored jointly by the UCLA School of Public Health Community Affairs and Development Committee and the UCLA Committee on Public Lectures, which is chaired

by Ruth Richards of the Division of Behavioral Sciences and Health Education. The panelists spoke to a capacity audience about "Venereal Herpes: The Underestimated Health Problem, the Undiscussed Social Problem." Dr. Robert Good, UCLA assistant clinical professor of obstetrics and gynecology, was joined by Dr. Yvonne Bryson, UCLA assistant professor of pediatrics, and Glenda Wina, health and science editor for KNXT, Channel 2 N ews. Dr. Telford Work, professor in the Division of Epidemiology, served as moderator.

"There are good reasons why genital herpes is a hot topic aside from its sh eer frequency," Dr. Good says. "First, it is very contagious. Secondly, it potentially can be transmitted to a child at birth. And, finally, the chance of cervical cancer is increased in women who have herpes." Even so, current research and understanding of the herpes virus have made the dangers and discomfort associated with the disease more controllable.

Genital herpes is caused most often by the h erpes simplex virus type two. (The type one strain of this virus results in oral herpes, more commonly known as cold sores). Genital herpes is usually spread through sexual contact with som eon e who is infected and is shedding the virus. A person with active herpes virus is advised to refrain from sexual contact un13

til all lesions are healed.

In her special television series on genital herpes, Glenda Wina described the symptoms of the disease: "About two to twenty days after exposure, the infected person may experience minor rashes or itching in the genital area. Then one or more painful, blister-like, fluid-filled lesions, sores or clusters of lesions usually develop.

They are often accompanied by swollen lymph glands, fever, aching muscles and a general sickly feeling. The sores dry up and disappear within a week to a month, along with the other symptomsbut this doesn't mean the disease is cured."

There is no known cure for herpes. It is a virus which stays in the body. Other veneral diseases like syphilis and gonorrhea are caused by bacteria and therefore can be killed by antibiotics.

Many men and women become so distressed at learning they have the disease that oftentimes their self-image is destroyed.

Sometimes their partners, misinformed about the virus, will break off the relationship, further adding to the emotional toll.

"When some people learn they have the virus, instead of viewing themselves as somebody ... they view themselves as somebody who has herpes," Dr. Bryson observes. She recently started a counseling group for herpes patients at the University Center for Infectious Diseases (UCID).

The center was established at UCLA nearly two years ago to treat patients with infectious diseases, including herpes, an d conduct research. Dr. Bryson is one of the first to test the oral use of a new drug, Acyclovir, for controlling genital herpes. She has recently submitted the initial resul ts for publication.

"Our studies show that oral Acyclovir does shorten the disease cycle significantly for both those who have primary and those who have recurring disease," Dr. Bryson says. "By shortening the course of the disease to one week, people don't spread the virus as readily 14

and their lives can be more easily managed."

Acyclovir is an antiviral agent which specifically attacks enzyme systems that cause the development of the virus. It is non-toxic and, therefore, safe for even pregnant women to use, the pediatrician says. She is continuing to investigate whether the drug has any significant effect on reducing or preventing the recurrence of genital herpes .

As of now, the body's immune system is its best defense. Statistics vary with whom you talk, but it is estimated that of the men and women who initially contract herpes, about 25 to 40 percent are never bothered again. According to Dr. Good, out of those who do have a recurrence, about half of those will be cured after three years, and about 75 percent will become immune after five years.

"So the majority of patients become immune themselves," Dr. Good says. He predicts that, since herpes is being acquired at earlier ages than in the past, immune systerns will build up defenses so that eventually the virus will not be so common in adults.

"Further, the dangerous aspects of the disease- transmitting herpes to a child at birth, or the higher rate of cervical cancer for women with herpes- can be controlled," the obstetrician/gynecologist says.

Babies born with generalized herpes can suffer devastating effects if not treated right away. The result can be death or ongoing neurological disorders. Dr. Good says, though, by carefully following women at risk through pregnancy, especially during the last four weeks, these catastrophies can be avoided.

Regular check-ups can also detect cervical cancer which, when found in the early stages, can be effectively controlled. 0

For more information about the University Center for Infectious Disease or the UCLA-UCID Clinic for Herpes Research and Support Group, call (213) 206-6723.

A1Ninning job

strategy The job search begins. You've studiously prepared yourself for the competition. You're on the mark with a graduate degree and experience in public health. Ready?

Set? Wait.

Before you go, first drop by the School of Public Health Placement Office. Here, Rob Grossbard, the director, will give job hunters the information, skills and direction needed to conduct an effective and realistic search .

"I'm here to help with every aspect of job searching," Grossbard says. "That includes critiquing resumes, preparing for interviews and videotaping practice sessions, compiling a library of employer directories and providing a list of job openings.

"Since this office is exclusively for the School of Public Health, I am able to spend time with individual counseling. I set aside ten hours a week just for that."

The placement office was established two years ago to help the School's students find jobs. It is a satellite of the main UCLA Placement and Career Planning Center and shares some of the central ofÂŁice's resources.

A major concern among aspiring public health professionals is recent cutbacks in governmental health programs which have t raditionally employed large numhers of the School's graduates.

"There is a lot of anxiety among students that it will be difficult to find jobs," Grossbard observes. "But I think that concern is valid only in certain sectors of the market, namely in federal and state civil service opportunities.

"But there are jobs in the private sector. Consulting firm s and private industry, for example, that employ specialists in health services management, environmental

Rob Gross bard, right, points out a potential ;ob for student Kevin Liu.

health, epidemiology and biostatistics are in fairly good shape and they are a viable part of the market."

He also points out that even though the budget for the Los Angeles County Department of Health Services has been significantly reduced, this is not necessarily the case in the adjacent counties of San Bernardino, Riverside and Orange.

Grossbard tailors each job search to individual backgrounds and career objectives. He is eager to counsel everyone from undergradua tes considering a career in public health ... to alumni looking for a new job.

To meet these diverse needs, he has organized a compreh ensive program that is continuously expanding. Besides the individual counseling sessions, Grossbard recently introduced a series of workshops which include resume preparation, interview practice and job search strategy. The workshops are open to alumni and students.

In his lectures, Grossbard stresses innovation when mapping out a job search.

"Most people are unsophisticated in their job search," he notes. "They go to the publicized market, like n ewspapers and journals, where there are published listings. Very few people are aware

that 80 percent of all jobs are unadvertised. There is a whole hidden market."

One untraditional strategy Grossbard advocates is the " information interview." This is when a job seeker contacts an employer a particular job, but not to ask for employment.

"You ask people who are actually practitioners in the field what they do day-to-day, what they like or dislike most about what they do, where they see the field going," Grossbard suggests. "You can then request from them referrals. Eventually you have formed a network on which to base your job search."

The placement office is in constant contact with employers.

Not only does Grossbard personally visit businesses, he also has organized two spring Career Days to bring part of the job market to the School.

From these contacts, and a mass letter writing campaign, Grossbard has been able to amass an impressive resource library. His directories include annual reports, pertinent statistics and descriptions, and sample job applications from businesses worldwide.

A major project this year is the organization of an alumni career resource network. Working with the School of Public Health administration and the School's Alumni Association, Grossbard wants to complete a comprehensive survey to locate where graduates are employed.

"We have 3,000 alumni out there," he says. "We need to tap into them as a resource for currently enrolled students as well as for spreading information among themselves.

"We want to bring alumni into the School as speakers. We want to encourage them to set up internships for students. And we want them to keep us abreast of current trends in the field." D

The placement office is located in Room 41-240A in the School of Public Health. For more information, call (213) 825-1886.

Building a strong network The ability of the Job Placement Office to serve the growing needs of our alumni and students depends upon the development of a strong and far-reaching network of friends and alumni.

Please take the time to fill out this card and send to: SPH Alumni Association, % Irene Fundaun, UCLA School of Public Health, Los Angeles, CA 90024. You are an important link in the School 's network.

Orgarization _ _ _ _ _ __ _ ___ Job title _ _ __ _ _ _ _ _ _ __ Address _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Business phone _ _ __ _ _ _ _ _ _ Home phone _ _ _ _ _ _ _ _ __ I am interested in participating in the SPH Alumni Career Resources Program by: _ _ Sponsoring student field visits and/or being interviewed for career information _ _ Participating in on-campus career panels _ _ Developing and sponsoring student internships _ _ Notifying the placement office of available job openings

15

When you pick up the Ti1nes, you p ick up Drs. Allin-Slater and Jelliffe It's Sunday morning and 2.8 million people break open their copy of the Los Angeles Times.

Many of them go right to the Home magazine section and eagerly turn to the Science Food H ealth (SFH) column.

"The reader response to SFH is tremendous," assistant Home editor Sunn y Gibbs says of the nutrition column which has appeared almost weekly for the last ten years. " When it is omitted becau se of lack of space, we get letters from readers saying they hope we haven 't discon tinued the column because their Sunday is not complete without it."

SFH is written by Ors. Roslyn Alfin-Slater and Derrick Jelliffe, professors at the School of Public Health in the divisions of Environ mental and Nutritional Sciences and Population, Family and International Health, respectively.

They are both highly respected in their fields and as result of the column, have become to many Los Angeles Times readers their experts on nutrition.

The au thors receive letters and phone calls from readers, and they answer each individually.

Dr. Alfin-Slater says she has taken the time to respond to such queries as: "How long can you keep pic kled herring in the refrigerator?" or "I take exception to you r stand that dietary cholesterol is not such a terrible villain ." In this latter case, Dr. Alfin-Slater sent the reader publications to support the s tatements she had made in the column.

Dr. Jelliffe muses that the letters he sees range from the laudatory ones, to those lambasting his "bias and ignorance," to those highly individualized on es like: "I take two teaspoons of sodium bicarbon ate each morning with the juice of a squ eezed mango ... would you advise me of the nutritional value?"

16

Dr. Jelliffe's imaginative m etaphors combined with his British sayings make him an entertaining communicator. Dr. AlfinSlater takes a down-to-earth approach to nutrition and reflects this in her writing. Through the years they have been able to complem ent each other's s tyles.

"We complem ent each other because we come from different but overlapping points of view," Dr. Jelliffe says. He has an M.D. in pediatrics, has worked primarily in developing countries and is knowledgeable in the history and cultu ral backgrounds of food. His particular area of interest is maternal and child feeding. Dr. AlfinSlater has a Ph.D. in biochemistry, has worked m ai nly in the U.S. and her interests lie in fats and cholesterol, heart disease, atherosclerosis and anemia.

"As a result, we have a nice blend and we work well together," Dr. Alfin-Slater says. "The fin al product is an amalgam of both of our contributions."

As is true with many sm ooth running operations, the co-authors just seem to flow through their work a nd are rarely concerned about missing a deadline.

Each comes up with ideas for columns

independen tl y, usually based on their research or something they have read or heard. Dr. Jelliffe, for instance, happened upon a publication on the value of arsenic as a nutrient. It was a topic totally aside from his main interests but, after researching th e poison, Dr. Jelliffe wrote an informative article, to which Dr. Alfin-Slater contributed, for SFH. The auth ors meet twice a year with the editors of Home magazine to discuss future topics. The editors then come up with new ideas and suggest articles that may run concurrently with a special feature. Most columns, however, are genera ted by th e authors' own ideas.

"The editors give us a lot of freedom ," Dr. Alfin-Slater says.

"They edit our copy to som e extent to fit into the space allotted or to put it into more understandable language when they think we are too technical, but they don't make that many changes. Over the years we have learned a little more about how to w rite for newspapers ."

With forty columns printed a year, the authors have composed nearly 400 articles over the past ten years. They can't recall repeats, although they do update certain topics when necessary. A glance through past columns reveals such headlines as: "Mood Foods," " Food Additives," "Fats in the Blood Stream," "Junk Foods," "Famine and Nutrition," "The Avocado" and "Pasta Power."

"We have to consider the audience," Dr. Jelliffe reflects. "They may be a little interested in famine and refugees but that's not their main personal concern. So we cater to what overlaps with their interests. In addition, we do run question and answer columns."

Recollections about how the column originated become fuzzier as the years go by, but the basic story is that it resulted from a chance discussion at an international nutritional meeting in Mexico. Drs. Jelliffe and Alfin-Slater met the food editor of the Times and they agreed the time was ripe for a newspaper column on nutrition.

"Both Dr. Alfin-Slater and I feel that the role of a university is to share any sort of special knowledge we have. Our role, as professors, should be to make that information available to the public," Dr. Jelliffe says.

"The real satisfaction derived from writing the column is to feel that you may be doing somebody some good," Dr. Alfin-Slater says.

One woman from Chicago wrote to report that she had lost twenty pounds following their suggested diet.

And, recently, Dr. Alfin-Slater was asked to speak to a California Commission on Nutrition in Grade Schools. The request came from a member of the commission who is a faithful reader of SFH. D

The :X's and Y's of genetic counseling

Debra Cheyovich diagrams a pedigree for students to show how genetic characteristics segregate in families.

Not everything goes the way one plans. But one can plan how best to meet those unexpected challenges.

Take, for example, a couple who is told that their baby will be born with a genetic disorder which may eventually cripple and/ or kill the child. How do they prepare themselves? To whom can they turn for guidance, facts and support?

As scientists better understand the causes of hereditary diseases (one of the most common causes of infant mortality in the United States) and with the discovery of newer and more sophisticated ways of detection and intervention, genetic counselors have stepped in to bridge the gap between technology and families.

Over the past ten years, the value of genetic counselors has been recognized in this country and, as a result, a few formal training programs developed.

This year, UCLA introduced a unique specialization in which graduates receive a master's in public health with a concentration in genetic counseling. It is the first curriculum of its kind to be based

in a school of public health.

"I like the idea of getting an M.P.H .1 11 says Melanie Ashe, a genetics undergraduate major who is currently one of six students in the first class. "I want to work in a major university or h ealth center, so knowing something about planning, policy, evaluation and administration is extremely advantageous."

The two-year curriculum combines courses and seminars in genetics, human reproduction, counseling techniques, psychosocial aspects of disease, epidemiology, demography, bioethics and health planning with a series of supervised clinical rotations and field placements. The program is funded by the March of Dimes and administered through the Division of Population, Family and International Health at the School of Public Health. Dr. Alfred Katz, who initiated the specialization, serves as director.

"In addition to emphasizing technical knowledge, our cur. riculum deals with the social and psychological reactions of people," Professor Katz explains. "Counseling is more than just laying out 17

facts or mathematical probabilities. It is a process of really learning to lis ten, to h elp patients deal with the ways in wh ich this is going to affect their lives ."

Debra Cheyovich, assistant director, adds: "Genetics is a very delicate subject. There are a lot of ethical and moral issues with which to deal - including abortion and confidentiality. It's also a highly technical field so that the material involved is not something that everyon e understands."

Most genetic counselors work in centers located in m ajor medical centers, similar to the setup at UCLA. The counselor works as part of a team wh ich may include ph ysician s, biochemists, nurses, social workers and clergym en .

The patients at these centers bring with them a variety of challenges. One may be a pregnant woman who, since she is over the age of 35, is at risk of bearing a child with a chromosome abnormality which could result in Down's syn drome, or mongolism.

She would be advised about the pros and cons of am niocentesis, a test of the amniotic fluid which can detect chromosomal disorders.

If she decides to take the test and the results are positive, the woman then faces the difficult choice of continuing or terminating the pregnancy.

Genetic counselors also see families who discover genetic diseases in their child after he or sh e is born. The family may need help in coping with the situation and feelings about themselves.

Scientific advan ces in research and technology continue to answer - and provoke-questions about genetic diseases. According to Dr. Katz, thousands of diseases are now attributable to genetic factors.

He says: "The process of genetic counseling is really to h elp people and families evaluate a known or possible genetic risk in relation to m aking decision s about the way this will affect their reprodu ctive behavior and future lives." D 18

Jo Alvarez: Gro11Ving 11Vith the School by Gabrielle Hammitt In 1958, what is now the School of Public H ealth was a not-very-large department housed in the north campus building now known as Campbell Hall.

"There were twelve faculty members, five secretaries and thirty graduate students," recalls Josephine Quesada Alvarez. "I can never forget that for some reason! " The reason is probably that Jo Alvarez is a m eticulous and organized recordkeeper, a trait which

._____a.__. fo Alvarez has served her well during her twenty-four year career with the School. From her first job as a secretary she moved into an administrative assistant position, running the Office of Student Affairs from 1964 to 1976. She became a student counselor five years ago, and is now the director of the School's new Counseling and Recruitment Center. Through the years, she has witnessed many changes and en ormous growth in the Sch ool, and is proud to have been part of it.

"When I was promoted to counselor in 1977, I was ready," she says. "It was a new challenge."

She m et the challenge with a combination of experience and dedication. Her door, to borrow a

phrase, was always open and still is.

"Jo was a person we singled out very early as som eon e to talk to when we h ad a problem," says Perry Brown, D r. P.H. '82 and former president (1973) of the Minority Students Association.

"She was always available to help."

Even then, eight years before a complete recruitment and retention program for minority students becam e a reality, Jo was sensitive to the special needs of disadvantaged s tudents.

Several years ago, the School 's administration asked Jo to develop an outreach program encouraging potential minority applicants to consider careers in public health.

A grant from the D epartment of H ealth and H uman Services for minority student recruitment resulted in the development of the H ealth Careers Opportunity Program. "This constituted a grea t expansion," says Jo. "We now have a comprehensive program including tutorial and summer enrichment courses."

She stresses that the center's general academic counseling and planning services are available to all s tudents. Not surprisingly, the multiple responsibilities keep her desk full. Jo also work s with various faculty committees.

"The thing is, I enjoy all of it," she says. " And when I enjoy something, I try h ard to fit it in."

Dr. John Schacher, assistant dean for academic affairs, has chaired a committee benefiting from her efforts. "Sh e really gives a committee continuity," h e says.

Perhaps Dr. Perry Brown summarizes her contributions best.

"There are certain mainstays in any institution," h e says.

"In the School of Public H ealth, Jo Alvarez is one of them." D

fo will be retiring from the School in ful y 1982 and plans to move to Arizona to be closer to her family

Food intake study may effect Third World policies

NEWS Tropical and geographic medicine course The resurgence of interest in infectious and parasitic disease problems associated with increased foreign travel as well as recent immigration patterns to the United States has been well demonstrated by attendance at an interdepartmental course in tropical and geographic medicine.

The first meetings of this course during Spring Quarter 1982 attracted more than seventy physicians, students, and allied health workers. Th e course, offered twice during the past three years, was developed by faculty from the school s of medicine and public health . From the School of Medicine faculty participants are from the departments of medicine, pediatrics, microbiology and immunology, and pathology. Public health fa culty include Lawrence R. Ash, A. Ralph Barr, Davida Coady and Clive Shiff from the Division of Epidemiology and Derrick Jelliffe, Charlotte Neumann and Susan Scrimshaw from the Division of Population, Family and International Health.

The course, which includes laboratory demonstrations, covers many infectious and parasitic diseases n ot usually emphasized in the curricula of U.S. medical schools and also encompasses problems associated with malnutrition and the cultural and behavioral aspects of di sease transmission.

The three hour, weekly evening sessions are approved for Category I continuing medical education for physicians. A highlight of this year's course will be the presentation in June of the annual John F. Kessel Lectureship in Tropical Medicine by Dr. Jacob Frenkel professor of pathology at the University of Kansas Medical School.

His talk will be on toxoplasmosis and other coccidian parasites of humans.

Dr. Ian Munro, editor of The Lancet, a prestigious English medical ;ournal, spent ten days at the School as a regent's lecturer. Regent 's lecturers are non-academic professionals, distinguished in their fields, who are invited to the University to share their expertise.

Dr. Munro gave a public lecture and interacted with faculty and students from the schools of public health and medicine.

Student honored Ruth Spanier, a graduate student in the Division of Health Services, was awarded a $1,000 scholarship by th e Federation of American Hospitals Foundation (FAH).

Spanier is one of seven students in the country to receive the award.

Her work experience includes internships at both the San Bernardino County Medical Center and the Nursing Division of Riverside County Health Department.

FAH is the national association representing more than 1,000 hospitals and hospital management companies. Criteria fo r the scholarship are financial need and sch olastic ability.

Malmgren gets top honors Roberta Malmgren, a graduate student in epidemiology, received the Distinguished Scholar Award from the UCLA Alumni Advisory and Scholarship Program.

The award, the most prestigious bestowed to continuing students, was given to three graduates and eight undergraduates chosen from among seventy applicants nominated by academic departments. Malmgren received the top graduate award of $3,500.

UCLA is participating in a collaborative, international study on the effects of reduced food intake on basic human functions-a study which may have far-reaching policy implications for future investments in food production in Third World countries.

Dr. Charlotte Neumann, associate professor of public health and pediatrics, is the principal investigator for the University of California, on the so-called "Kenya Project." For the next fi ve years, she and other UCLA specialists will be working jointly with the University of California, Berkeley (UCB) and with counterparts at the University of Nairobi to study " moderately" malnourished populations in Kenya. Two other projects, one in Mexico, conducted by the University of Connecticut, and one in Egypt, by Purdue University, the University of Arizona and the University of Kansas, complete the collaborative study.

"The most widespread global problem is people not getting enough calories. We will be trying to determine what functional effects, if any, moderate energy intake deficits have on such human functions as: disease response, reproductive competence, work output, cognitive function and social and behavioral function/' says Dr. Neumann, who has been involved in several studies of severely malnourished populations.

The study is funded through an $11.8 million grant from the U.S. Agency for International Development. UCB, through a management entity, will provide scientific and administrative direction to the three collaborating projects.

Other UCLA participants include Anne Coulson and Dr. Abdelmonem Afifi of the School of Public Health, and Drs. Richard Stiehm and James Cherry of the School of Medicine.

19

DEAN'S COUNCIL Th e Sch ool 's programs were en h anced last year th ank s to th e generosity of the eigh ty-eigh t members of the Dean 's Cou ncil who together dona ted m ore than $10,000 in 1981.

Activities supported by th e D ean's Council included the spon sorship of s tuden t research; a public symposium on herpes virus infections; a School exhibit at t he annual m eeting of the Am erican Public Health Association; an alumni m eeting in Washington, D .C.; reception s for n ew public health students; an orientation prior to the first day of the new school year; and a reception for

graduating s tudents and their families.

Dean 's Council m em bers are alumni and fri ends wh o donate $100 or m ore annually; the gifts are tax-deductible. Members receive library privileges at the UCLA Biomedical Library, in forma tion on special even ts at the School, and can participate in social and professional gatherings.

We thank all the m embers lis ted below wh o are members of the D ean 's Council for 1981.

If you are interested in joining the Dean's Council, please contact Judith Angel at (213) 206-8226 .

1981 members

f oh n H. M ad er Robert A. M ah, Ph. D .

Fra n/< /on es M assey, fr. , Ph.D .

Frank P. M atrica rdi , M .PH. foseph R. M cCar t hy, M.PH. funills M . M clnlire, Ph. D .

Lester A. M eis fudge Leon ard T. M en de lsoh n M ari e E. Michnich . Dr.P. H . /eon L. Mickey, Ph. D. Rober t D. Montoya, M . P.H. C harles N. Moss. D 1:P. H .

A lfred K. Neumann. M. A., M . D .. M .P.H. Ru by S. Oku bo, M. l~ H. Ed w ard f. O 'Neill, M .D .. M .P.H .

Elizabeth M. Ost erkam p, M .P H . f ames /. Pal m ersheim , D1: P.H. O l a Faye Pearson , M .P. H. D onal d W Po lhemlls, M .D .. M.P.H. Edward L. Rada, Ph.D. Ronald C. Retzer, M.P. H .

Shirley W Ri ch . M. P. H .

Ruth F. Rich ards, M. A., M . P.H. St anley N. Rakow. M .D. H arol d H. Roya ltey, M .D ., M .P.H. Ralph R. Sach s. M .D. Alan Samllels M arlowe H. Sch affner, M .D .. M. P.H. M ax H . Schoen , D. 0 .S .. D r.PH. Jamar f . Schoessow, M. P. H .

Stuart 0. Sch we i tzer, Ph. D. M arie M . Segarra, M .P.H. Robert H u rd Sett/age, M.D., M.PH. Fran Antley Sh erwood, M. P H .

William Shonick , Ph. D. M arian E. Swendseid, Ph.D .

Fores t S. Tennant, fr. , M. D .. M .P.H., Dr.P.H .

Sam uel f. Tibbi ts Sue Veri ty, D r.PH. Barbara R. Vissch er, M .D .

Fred W Wasserman, Dr.PH. Graem e A. W William s, M .D., M.P.H. A l ton E. Wilson Mimi C. Yu, Ph .D .

Adrienne P. Ziegl er, M .P. H.

Ro lyn 8. Al/in -Slater. Ph.D. I ra R. Alpert Elise C. W A n derson Lawren ce R. Ash, Ph.D. William A. Benbassat, Dr.P H .

Lester Bres/01-v, Jyl.D .. M. l~H. fames M. Cameron, M .P.A., Ph.D. Edith M. Carlis l e. Ph.D. Virginia A. C lari<, . Ph.D. Roger A. Clemens. Ph .D., M.P H .

Anne H. Coulson William G. Cumberlan d, Ph .D .

I rvin M. C ushner, M.D .. M .P. H .

Climis A. Davos, Ph.D. Roger Detel s, M.D .. M .S. Bri an P. Dolan , M.D .. M.P. H .

O live /eon D unn. Ph.D. foe / M. Ellensweig, M.D., M.l' H .

Sam El rod aka George Prall. Ill George E. W Euim a, Dr.P.H .

Nat al ie S. Felix , M.D .. M.P. H. f onath an E. Fiel ding, M.D .. M. P.H. Pau l M. Pl ei ss, M. O., M. PH., F. A .A.P. St efanie Foote, Ph.D., M .P. H. Katherin e L. Goldsmith . D r. P.H. Raymond D . Goodman . M .D., M.P H. C harles M . Goldstein, D.D.S.. M.P.H. Donal d f. Goodwin, Dr.P H .

C arl E. H opkins, Ph.D.. M.P. H. f ames M. Hllbbard, f r., D.D.S., M. P.H. Joseph K. l ndenbaum, M .D.. M .P.H. fu el f an is, Ph.D. Pall / S. f aret t Derrick 8 . f ell iffe, M.D. Wi l bert C. fordan, M.O., M .P.H. Sneh end u B. Ken; D r.P. H. Leon ard Kl einman, M.D .. M.P. H .

A l ma L. Koch , Ph. D. Caro /beth G. Korn f oe / W Kovner. D r.P. H .

Donal d A. L evine. M .D., M.P. H .

O r. Ange I . Lobue, M.P. H. f. Ph illip Loge. M .D.

20

IBM personnel director gives Breslow lectureship Industry sh ould take a fresh look a t its role in public health, according to a recent guest speaker at the School of Public Health. Businesses may do them selves a favor by helping to keep their employees healthy.

Robert Beck, IBM 's director of ben efits, h ealth programs and personnel services, discussed som e of h is com pany's health promotion activities at the second annual Lester Breslow D is tinguished Lecture held at UCLA in January. T he lectureship is sponsored by the UCLA School of Public Health Alumni Association through a gift from the Raymond and Betty Goodman Foundation . It honors Lester Breslow, dean emeritus, w h o retired last year after serving as dean since 1972.

Spurring indus try on to take a new stan ce towards public health is the simple fact that the cost of em ployee m edical ben efits is esca lating each year. Beck said IBM pays out $200 million a year for employee m edical costs.

"Our benefi ts plan has not ch anged since 1971 bu t our costs have been going up at a 14 percen t compound rate each year. This can be attributed to an increase in utilization of benefits, inflation and high technology costs," he said.

IBM's two-pronged program focu ses on h ealth protection in th e workplace, and health promotion at work and hom e. He said the corporation, which em ploys 200,000 people in th e United States, is developing a compreh ensive health prom otion strategy which includes h ealth education, early detection throu gh multiphasic screening, employee programs, redesigning benefit plan s, controlling financial contributions of the corporation, research an d external activities. Some of these compon ents are still in the seed stages but oth ers h ave already s tarted to bear fruit . " Our weakest link when we started this t wo years ago was

health education," Beck said. Today, IBM offers employees, spouses, children and retirees a variety of health education classes for which the company pays. Participants can tackle smoking cessation, stress managem ent, exercise, back ailments, weight managem ent, first aid, cardiopulmonary resuscitation (CPR), risk factor management or h ealth nutrition.

In addition, the company's multiphasic testing has helped detect serious health problems of which employees were unaware.

These have included h eart disease, diabetes, elevated blood sugar, hypertension and cancer. UCLA researchers are currently working with IBM to sort through the data from these tests so that an age/ risk oriented schedule can be developed to replace the current arbitrary one of testing employees every five years after the age of 35.

Industry can, and should, play a bigger role in exploring today's pertinent health issues, Beck stressed. IBM is directly or indirectly involved in exploring su ch concerns as inappropriate utilization of hospitalization, the cost effectiveness of second opinions before surgery, home h ealth care, health maintenance organizations (HMOs) and alternative benefit plans.

In photo below, Robert Beel<., center, meets with Dr. Lester Breslow, left, and Dean Roger Detels.

NOTES .Alumni Elestia Shackelford, B.S. '4 8, has been chairman of the Andrus Volunteers at the USC Geronto logy Center s ince her retirem ent in 1975.

Suzannne Dandoy, M.D., M.P.H. '63, Epidemiology, professor of health adm in ist ration at Ari zona State U n iversity, has received a research gra nt to s tudy the prevention of hepatitis B among hospi tal cm · ployccs, and a grant t0 in vestigate h ea lth promoti on progra m s m arketed tO business and industry.

Emilia Fisher, M.P.H. '63, Healt h Education, is coordinator of Special Ed uca tion and Programs and Services at the Los Angeles Trade Technical Co llege.

Ruby Okubo, M .P.H . '66, Health Services, is manager of m edica l/admini strati ve applications for Hospital Computing Services at the UCLA Hospital s and C linics.

Harry Houston, B.A. '68, is owner of hi s own managem ent firm fur nursing ho m es, Health Quality Planning Service, Inc., and serves the industry as a cons ultant.

Ange Lobue, M.D ., M .P. H. '69, Health Ser· vices, is a Dipl omatc of the Ameri can Board of Psychiatry and Neurology, assis· tant clini cal professor of psychiatry and neurology at UC LA and director of the offi ce of Health In formation and Servi ces for Roche Laboratories. In additi on to a limited pr ivate practi ce, he has been lecturing and conduct ing workshops and seminars throughout the United States on t0pics ranging from psych opharmaco logy and s tress managem ent to interviewi ng en · han ccment and the art of listening. He has been a guest on numerous radi o and televi s ion s hows, and is particularly in terested in the relation ship between media and m edicine. Hi s biograph y is listed in Marquis' Wh o's Who in the West.

Ecleamus Hicks, M.P.H. ' 72, H ealth Admin istration, is d eputy comm issioner for physical h ealth at the Fulton County Health Departm ent in Atlanta, Georgia. Pri or t0 hi s present posi tion, he was executive directo r/ administrat0r of the Southside Community Health Center in Atlanta.

Stewart Blumenfield, Dr.P.H. '73, Health Administration, a researcher in the Divis ion of Population, Family and International Health at the UCLA School of Public Health, is currently a senior evaluation ad· visor for the Office of Nutrition of t he U.S. Agency for International Development where he manages projects in Panama, Honduras and the Ph ilippines.

Jeff Harris, M.D., M.P.H. '74, Health Services, a private pract it ioner in Malibu, and Peggy Harris, M .P.H. '75, Health Services, active with the American Can cer Society and other commu nity projects, had their second child, Megan Bi rkins, on January 20. Thei r o lder daughter, Jenny, is six years old.

Dorothy Johnson , Dr. P.H. '75, Health Services, con tinues to teach at Califo rni a State College in San Bernard ino. She's teach ing part-ti m e and says she wi ll probably retire soon. She is livi ng in Leisure World in Laguna Hills.

Stephen Inkelcs, M.D., M.P.H. '78, Environ m enta l and Nutritional Sciences, fini shed in Jun e a t hree-year residency program in internal m edicine at the Uni versity of California, Irvine Med ical Center. In July, he w ill start a two-year fe llowship in cl in· ical nutriti on at the Oregon Healt h Sci· en ces Universi ty, Department of Medicine, Divi sion o f Endocrinology, Metabol is m and Clinical Nutrition in Portland, Oregon . He recentl y published hi s first arti cle, " Hypcrlipidemia and Coronary Atherosclerosis: A Review" which appeared in the March 198 1 issue of Medicin e.

Diane Hoss-Simon, M.P.H. '78, Heal th Education , is t he vice president for adminis trati on and director of ed ucation and community services for the Arthr itis Foundation, Southern California chapter.

Ronald Nakamura, M.P.H. '81, Behavioral Scien ces and Health Education, is t he ed ucator genera li st for the Tulare Cou nty Department of H..:alth . H is responsibili ti es include coordinating staff t raini ng and new empl oyee ori entation, teachi ng stop· smoking and CPR classes and acti ng as a C HOP health educator.

In memoriam Aldo Facca, M .P.H . '67, Health Admini stration

Potluck dinner The International Potluck Dinner was a gourmet's delight as more than eighty alumni, s tudents and faculty gathered at the West Center February 28 for an informal potluck meal.

The participants feasted on fifty different dishes which ranged from Texas-style chili to Chinese dumplings. The dinner is an annual event sponsored by the UCLA Public Health Alumni Association.

21

Faculty We were pleased to hea r from the fo llowing facu lty who reported their recent activities: Judith Blake, Ph.D., professor, Population, Family and Internat ional Heal th , was the 198 1 president of the Population Associati on of America . She was also elected a fellow of the Arncncan Association for the Advancement of Science.

Lester Bres low, M.D., M.P.H., professor, Health Services, will receive the 1982 UCLA Alumni Association award for university service at the Awards Ceremony on Saturday, June 5 in fro nt the James E. West Center.

Marianne Brown , M.P.H., adju nc t lec ture r, Behaviora l Sciences a nd Hea lth Education, and severa l students from t he School helped organize a com munity lecture on " Reproductive Hazards in the Workplace."

The one-day conference for workers was sponsored by the L.A. Comm ittee on Occupational Safety and Health, a coalition of health profe sionals and workers interested in educati on.

Albert C hang, M.D., M.P.H., professor, Population, Family a nd International Heal th, received the 1981 Young Profess ional Award from the maternal and childhealth section of APHA for his work as director of the California Center for Child Passenger Safety. nalph Freri c hs, D.V. M., M.P.H. , Dr. P.H. a nd Jess Kraus, Ph.D. , professors, Epidemiology, were elected in 1982 to members hip in the American Epidem iologica l Society. Membership is limited co 150. Elect ion is recogniti on of leadership in the field of epidemiology.

Derrick Jelliffe, M.D., professor, Population, Fami ly and Inte rnational Health, has been awarded an honorary M.D. degree by the Univers ity of Uppsala, Sweden. T he university be stow~ one such award each yea r.

E. F. Patrice Jellife, R.N., M .P. H ., lecturer, a nd Derrick Jelliffe, Population, Fami ly and Inte rnational Health, were cons u ltants co the Chin ese Academy of Medical Sciences on young child feeding; co-organized the joint IUNS/ INCS Works hop on " Household N utrition-Appropri tc Technology," in Colombo, Sri Lanka ; co-orga nized the Internat iona l Nutriti on Congress in San Diego; and co-organized a Pacific-wide satell ite conference on recent trends in m a ternal a nd young chi ld feed ing in the South Pacific islands.

Milton Roem er, M.D., M.P.H ., professor, Hea lth Services, recently published Ambulatory !-lea/th Services in America, a comprehen sive stud y of the total range of organized ambulatory hea lth services.

Dianne Moore, C.N.M., Ph.D., assistant professor, Popu lati on, Family and In ternati ona l Heal t h, is the assistant editor of the journal of Nurse-Midwifery, and chairwoman of the resea rch commi ttee of the Divi sion of Exa mi ners of the Am e rican College of Nurse Midwives. Recent pu blications in clude: "Prepared C hildbi rth : The Pregnant Couple and T heir Marital Satisfactio n," in Nursing Uesearch ; and Patients Evaluation of t he Prena tal a nd Delivery Care," and " Body Image in Pregnancy," both in Swdies in Parent- Neonatal Nu rs ing.

Telford Work, M.D., M.P.H., professor, Epidemiology, was the recipient of the 1981 Ri ch a rd M . Taylor Award given by the American Committee on Arthropod-Borne Viruses for signi fican t contri butions to t he virology, immuno logy e n tom ology, eco logy o r epi de m iology of art hropod-bo rne viruses.

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Mail to: Irene Fundaun, UCLA School of Public Health Alumni Association, Dean's Office, School of Public Health, UCLA, Los Angeles, CA 90024.

22

In memoriam Dr. Govind Dhopeshwarker, adjunct professor, died from a h eart attack on April 1. He was 58 years old.

Dr. Dhopeshwarkar, a native of India, received his Ph.D. in biochemistry from the University of Bombay. Hi s first appointment at UCLA in 1967 was as a researcher in the Laboratory of Biomedical and Environmental Sciences. In 1972, h e joined the teaching faculty of the School of Public H ealth.

As adjun ct professor, he participated in the teaching program in the Divi sion of Environmental and Nutritio nal Sciences. His seminar, Nutrition and Brain Development, was popular with students and his lectures in other courses were well received.

----¡---Dr. James Arthur Waites, former faculty member and administrator in the School of Public Health passed away on March 23 at the age of 68 . Dr. Waites was first appointed to the School of Public Health as a lecturer in 1965 and became assistant dean of student affairs in 1970. He also served as director of what was known as the Program in H ospital Administration until his retirement in August of 1972.

Trained in the field of psychology with a doctorate from the University of Manchester, England, Dr. Waites had extensive experience as director of psychological services for several vete rans administration facilities. His expertise in organizational behavior and systems theory enabled him to make important contribution s to the School 's teaching and research programs.

Dr. Waites will be rem embered as a congenial faculty m em ber and an able administrator who served faculty, students and staff in the School of Public Health with strength, personal warmth and a sense of humor.

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Outstanding achievement awards were presented by the School of Public Health Alumni A ssociation to the top graduating students in each of the School's six divisions. The awards were given at the fun e Reception and Awards Ceremony held fune 7 at the Faculty Center. Winners were (from left): Evelyn Bradley, Health Services; Terri Walsh, Epidemiology; Francine Coeytaux, Population, Family and International Health; fane Youn g, Behavioral Sciences and Health Education; Sherry Lowy, Environmental and Nutritional Sciences; and Stein Vollset, Biostatistics.

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