September 2, 2022

Dear Medical College of Georgia Friends,

Finding new colleagues in Scotland

With so much work to do here, like so many of you, I often find it hard to get away (plus I am a homebody at heart). But last week’s visit to Scotland with Provost Neil MacKinnon, College of Nursing Dean Tanya Sudia and director of protocol and special events Gia Johnson to pursue partnerships with the historic Robert Gordon University and University of Aberdeen, proved to be a fascinating glimpse of a country and a people who felt a lot like home. There are clear distinctions. They have the National Health Service Scotland, which means health care and medication are provided free to all. But they acknowledge problems like long delays in patients getting some needed surgeries like joint replacement.  Scotland is about the size of South Carolina with a population of just over 5 million. It’s largely rural, but a relatively small percentage of the Scottish people live in rural regions, while cities like Glasgow, the capital city of Edinburgh, Aberdeen and Dundee are home to a much bigger percentage of the people, like they are here in Georgia. We also share with the Scottish people common killers, including heart disease, cancer, substance abuse and stroke. We share a desire to better serve rural populations, and common approaches like telemedicine to help eliminate distance as a factor in access for the people we are privileged to serve.

The University of Aberdeen Medical School has 500+ year-old roots

Also, like our state, there are five medical schools in Scotland. We were honored to visit the University of Aberdeen Medical School, which is officially the School of Medicine, Medical Sciences and Nutrition. The university’s roots reach back to 1497 and its history tells us they have been teaching medicine to some degree since those earliest days, but formal establishment of the medical school appears to have been in the late 1700s. We are historical as well by our own country’s timelines, established in 1828 as one of the nation’s first medical schools (13th to be specific). Dr. Siladitya Bhattacharya, an OB/GYN, is the Head of the school, an accomplished physician scientist, nice man and gracious host whose many accomplishments include serving as longtime chair of the International Network for Research in Reproductive Medicine and as editor-in-chief of the journal Human Reproduction. You have been hearing me and others talk a lot lately about primary care, well in Scotland general practitioners are definitely the frontline and they practice with a great deal of autonomy. And, like us, improving rural health care is on the top of the list of things that need doing. Taking the lead are people like Dr. Debbie Miller, a general practitioner who runs the Nairn Healthcare Group, which includes a small cottage hospital in this town in the Highlands, an old fishing port that today is a beautiful resort town that sits on the River Nairn and the North Sea. This group of doctors really does it all, including making house calls as well as providing inpatient and outpatient care and they have a telestroke program to, like us, better address this primary cause of death and disability. We met with Dr. Mary MacLeod, who grew up on the historic, scenic Isle of Lewis, one of the Western Isles of Scotland, and is today a senior clinical lecturer at Aberdeen, whose primary clinical interest is stroke. I sat next to her at dinner one night and learned a lot about growing up in the Western Isles and how rural stroke care happened in Scotland, which is a lot like how it happened in rural Georgia.  Like our stroke specialists here, she also takes telestroke call to enable timely stroke care where people live and proper transfer if they need more care, like mechanical clot removal and/or potentially ventilator support. I also was fortunate to share dinner and time with Dr. Rona Patey, an anesthesiologist who directs the Institute of Education Healthcare and Medical Sciences at Aberdeen and so oversees medical education there.

Maternal, infant mortality rates and prostate cancer are common targets

People like Dr. Pauline Wilson, who grew up in the more remote areas of the Shetland Islands, which are about 230 miles north of Aberdeen, and today practices in the community she loves as she strives to find even better ways to provide care, including working to ensure the next generation. For her work, she has been honored by the Royal College of Physicians of Edinburgh with their inaugural William Cullen Prize for Excellence in teaching/service innovation in the National Health Service in Shetland. Very much on her radar now is, again like our state, addressing unacceptable maternal and infant mortality rates. I learned a lot about their successful midwifery program in Scotland. In fact, our traveling companion and nursing school dean Dr. Sudia and her leadership team are seeking as we speak to add a midwifery program to their Doctor of Nursing Practice program to help address this huge problem in our state. Please note that our Dr. Sudia also has been honored for her work and leadership by the interdisciplinary National Academies of Practice. We met Dr. James N’Dow, a native of the small West African country of Gambia, chair in surgery at Aberdeen University, who has directed its Academic Urology Unit since its founding more than 20 years ago. He is a prolific investigator currently coordinating a European Multidisciplinary Consortium of 35-partners and 9 countries to see how big data on the common problem of prostate cancer can better inform clinical practice. His work is and has been well-funded by the European Union Innovative Medicines Initiative, the world’s biggest public-private partnership in life sciences. He cofounded the Urological Cancer Charity, which has done amazing things like bring the first robotics surgical system to Scotland and contributing more than $2.5 million to the University of Aberdeen for urological cancer research. He is yet another bright, humble and super nice individual who is concerned about access to good care in rural areas. I am pleased that Dr. N’Dow was awarded visiting faculty status by AU and we are looking forward to working with him (and all our new colleagues) and hoping he will pay MCG a visit soon. BTW, he reminds me of a more senior Dr. Zach Klaassen, who no doubt will have a similar profound impact in urology and is already a prolific investigator and physician in genitourinary cancers right here.

Stroke and rural health care provide more common ground

As icing on the cake, we were also shown a copy of a speech given to our graduates April 2, 1838 by the Rev. Elijah Sinclair, a member of the Board of Trustees at Aberdeen. I wish I could talk about all the interesting individuals we met and things we learned, but I think you already see what I mean by the commonality between us. While it was a jampacked visit, particularly in retrospect, it was also an insightful, invigorating and definitely scenic adventure, in a country where sheep roam everywhere and dolphins are another common sight. There also are plenty of cows, including the Highland cow, which kind of looks like a mix between a Shetland Sheep Dog, a deer (or maybe a bear) and an actual cow with horns, but I guess we did not get high enough up in the mountains to see these unique creatures. But what we did find was a beautiful country whose people are welcoming, bright and humble. We found a sister state in a foreign land. Thank you all for your incredible graciousness and for working with us to foster a healthier world. A particular thanks as well to Gia Johnson for her hard work in coordinating this visit and to Provost MacKinnon for making it happen. Read more here.

Dr. Sergei Kirov and team find surprising player in stroke damage

As we just talked about, stroke is a major cause of death and disability in this country, in Scotland and in the world, according to the Centers for Disease Control and Prevention. That is why our stroke specialists and neuroscientists here and everywhere work hard to learn more about this pervasive condition, including better understanding how and why damage to the brain continues in the hours and even days following a stroke and what can be done to contain it.  Also in keeping with our other coverage of international collaboration, Dr. Sergei Kirov, neuroscientist in Department of Neuroscience and Regenerative Medicine, worked with Dr. Iris Álvarez-Merz, also now a neuroscientist, who was then a graduate student at the Universidad Autόnoma de Madrid, to learn that one contributor is nonexcitatory amino acids. These amino acids normally make proteins important to brain function, but also are among the first escapees from the blood brain barrier, the layer of super tightly connected endothelial cells that line blood vessels in our brain. Those connections can loosen in the aftermath of stroke as well as other brain injury, and they’ve found these nonexcitatory amino acids leak out. Thanks to the super sophisticated imaging we have here, they could watch as neurons filled up with these escapees, which attracted sodium, which attracted water, which like anything, can be problematic in excess. Brain cells called astrocytes that take care of neurons at that point focus on themselves, opening channels to let excess water and molecules out, but the excitatory neurotransmitter glutamate escapes as well. Destructive bottom line: neurons become overstimulated, injured, enlarged and can burst and die. Great work that provides more valuable insight about our invaluable brains. Check out more here.

Dr. Bill Bloodworth, President Emeritus of Augusta State University, longtime tech Jerald Schlein, pass Finally today, we recognize the passing of another good man who led by example and genuinely cared about the people who worked with and for him. Dr. Bill Bloodworth was president of Augusta State University for nearly two decades. He was also a prolific and happy English and History teacher who returned to teaching after his retirement from the presidency in 2012. Our thoughts are with Dr. Bloodworth’s family and many good friends and colleagues at his passing.  Please let me also today note the passing of Jerald Schlein, an environmental service tech here for 31 years. Jerald was a familiar, friendly presence in our Sanders Research and Education Building and Georgia Cancer Center, and he already is very much missed. Again, our thoughts are with his many friends and family. It is individuals like both these gentlemen who make an institution outstanding.

All my very best to you,

David C. Hess, MD
Dean, Medical College of Georgia

Upcoming Events

Sept 16 – MCG Faculty Senate Meeting, noon, Natalie and Lansing B. Lee Jr. Auditorium

Oct 16 – PaceDay 2022, Georgia Cancer Center Paceline Ride

Oct 21 – MCG Faculty Senate Meeting, noon, Natalie and Lansing B. Lee Jr. Auditorium

Oct 21 – Raft Debate, 6 p.m., J. Harold Harrison, MD Education Commons

Oct 22 – White Coat Ceremony, 2 p.m., Bell Auditorium

Nov 11 – Annual Body Donor Memorial Service, 1 p.m., Natalie and Lansing B. Lee Jr. Auditorium

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