From Tampa to Tampa
A personal essay by Lawrence Levitt, M.D.
Imagine being confronted at age 27 by hostile student council members at an American university, trying to explain why 500 of their fellow students had suddenly fallen ill with abdominal pain, nausea and vomiting. The council members, sitting stiffly in leather chairs in a wood-paneled conference room, were convinced that the epidemic was due to food poisoning caused by their cafeteria’s food provider. I was trying to tell them that the data that I had collected as a green and inexperienced U.S. Public Health Service officer indicated otherwise. "The illness is very likely due to a virus,” I said. They remained unconvinced. One student, a tall, blond young woman, surprised me by standing up and shouting, “You're being paid off to say this!”
This exchange took place in 1967 at the University of South Florida (USF) in Tampa, Florida, during my first assignment there as an Epidemic Intelligence Service Officer assigned by the National Communicable Disease Center (NCDC). As a newly-minted MD, I held a joint assignment working for the U.S. government assigned to the Florida State Health Department, with part-time duties at the Hillsborough County Health Department. After a whirlwind six-week course in epidemiology at the NCDC, I was told that 500 students were seriously ill at the University of South Florida--and that it was my job to figure out why.
Tentatively, I concluded that a common-origin airborne outbreak had occurred at a social event that the affected students had attended. The illness was not food-borne. That impression was subsequently confirmed as other students who had not eaten in the cafeteria became similarly ill. Ultimately, the symptoms were attributed to “Winter Vomiting Disease," a viral illness, and subsequently reported in The American Journal of Epidemiology.
Thus began my two-year experience in Tampa in the U.S. Public Health Service, which would come to shape my life as a doctor. Here I would learn the importance of not merely treating patients, but of trying to improve the health of whole communities.
The Power of Prevention
My duties in Tampa included working at the Encephalitis Research Center under the direction of - believe it or not - Dr. James Bond (not “007”). Tall and balding, he was senior virologist and epidemiologist at the Florida State Health Department. I also made rounds at Hillsborough County Hospital, which cared for indigent patients, and at Tampa General Hospital, where those with insurance were admitted. The differences between the two hospitals were striking. Tampa General offered pleasant accommodations for patients and was well staffed, with specialists in every area. Patients at Hillsborough County Hospital, by contrast, lay in beds in large, crowded open wards. Nurses there communicated by phone with a supervising physician, who made rounds several times a week. This dichotomy in the quality of healthcare, based on one's financial resources, made a deep impression on me. Wasn't there a better way to provide health care to a community?
Under Dr. Bond’s supervision, one of my main duties was to deal with the occasional case of St. Louis encephalitis, a mosquito-borne illness, which caused fever, headache and sometimes confusion due to inflammation of the brain. In rare cases, patients died from the disease. Dr. Bond was an excellent virologist and epidemiologist who quickly realized that the key to controlling the problem was to reduce the population of mosquitoes that carried the virus. Thus, our Encephalitis Research Center cooperated with Florida State authorities, which sprayed areas known to breed mosquitoes in a successful effort to reduce the viral load. My work took me on rounds at both hospitals, where I saw patients suspected of having this form of encephalitis, taking histories, performing physical examinations and doing an occasional spinal tap. It was here that my interest in neurology began, and my commitment to preventive medicine deepened.
At this time, we faced another major challenge: childhood measles. By the 1960s, measles had become the number one cause of acquired mental retardation in the United States, due to measles encephalitis or inflammation of the brain. Immunization with Swartz vaccine had just become available, and it was my assignment to organize a measles immunization effort that would prevent the virus from taking hold in the Tampa Bay area community. This experience involved working with local pediatricians and the Hillsborough County Pediatric Society. We held strategy sessions and met with County officials.
Meanwhile, The Tampa Tribune widely publicized “Measles Sunday,” which helped our efforts enormously. On just one Sunday, 28,000 injections were given for a dollar per shot. The program was highly successful - to my knowledge, there were no cases of measles in the Tampa Bay area for years to come. I was greatly influenced by this experience, because it allowed me to see firsthand the cost-effectiveness of preventive medicine measures and community distribution of a quality care initiative. Just one case of measles-acquired retardation would cost society hundreds of thousands of dollars, not to mention the steep emotional cost to affected families.
One Man’s Dream: Lehigh Valley Hospital
In 1968, I received a visit in Tampa from Leonard Pool, founder and CEO of Air Products and Chemicals Inc., a Fortune 500 company based in Allentown, Pennsylvania that supplies oxygen, nitrogen and other products to hospitals throughout the world. I had first met Leonard when I cared for his wife, Dorothy, as a first-year resident at Memorial-Sloan Kettering Cancer Center in New York City. Now, here in Tampa, Pool began talking to me about his dream of building a hospital in Allentown Pennsylvania, so that patients in his community who could not afford to travel for medical care in Philadelphia or New York, might get first-rate care locally. That vision was the genesis of Lehigh Valley Hospital in Allentown.
Mr. Pool kicked off the initial fund drive for the hospital, which opened in 1974 with a $5 million donation. When he died in December 1975, he left the bulk of his estate to fund the Dorothy Rider Pool Health Care Trust, named after his late wife. His goal was to help Lehigh Valley Hospital, become a “superior regional hospital" and to ”provide superior healthcare to my fellow man." I was honored to be chosen as one of the Health Care Trust’s initial Trustees, along with Pool's successor at Air Products, Edward Donley. Bob Cathcart, CEO of Pennsylvania Hospital, and several former deans of top medical schools who would serve as Trustees in future years. Over the last 35 years, the Trust, which began with an endowment of $15 million, has distributed more than $90 million. It has funded such diverse projects for Lehigh Valley Hospital as a Level 1 Trauma program, a burn center, a cancer center, a stroke center and Pennsylvania’s first hospice. The Trust has supported various projects in medical education, clinical research, and continuing education programs for physicians, nurses, medical students and other health care staff. Importantly, it has also funded key prevention projects, including "Smoke-Free Lehigh Valley" and the fluoridation of Allentown's water supply.
The Anti-Cavity Campaign
Since the 1950s, several unsuccessful attempts had been made to fluoridate the Allentown water supply. Since the water in neighboring Bethlehem and Easton had been fluoridated for decades, every local dentist knew at a glance where their young patients lived. Generally, the Bethlehem and Easton children had reasonably healthy teeth, while those from Allentown had mouths full of decay. Taking on the politics of changing this situation was a daunting challenge. By now, I was a neurologist at Lehigh Valley Hospital, but community health issues continued to capture my attention. The level of tooth disease suffered by Allentown children alarmed me, and it also concerned Edward Meehan, Executive Director of the Pool Trust. So, in 1993, we decided to give fluoridation a shot.
We enlisted the help of two key players in the community: Jack Karabasz, a dentist who was deeply concerned about the problem, and Frank Concannon, who sat on the Allentown City Council, the body charged with approving—or disapproving—the addition of fluoride to the water. None of us minimized the obstacles, including the attitude of one member of the Council who was famous for saying, ”I'm not going to cook my pasta in fluoridated water!" Others in the community were convinced that fluoridating the water was a “left-wing conspiracy” that would cause cancer, bone fractures and other miseries, without scientific evidence to support these concerns.
Fortunately, the local dental and medical communities were united in their willingness to help. We were able to enlist dentists, pediatricians, family physicians, oncologists, orthopedic surgeons and others to join us in the effort. The Allentown Morning Call wrote supportive articles. Finally, in Dec of 2000, the city of Allentown agreed to fluoridate the water, provided that the Pool Trust would cover the initial equipment costs of $500,000, which it gladly did. It has now been 10 years since the water was fluoridated, and rates of tooth decay in Allentown have declined dramatically. Dentists can no longer tell whether a child comes from Allentown, Bethlehem or Easton by just looking inside that child's mouth!
Training Doctors for the Future
Of course, providing first-rate health for a community requires the best in medical training. Lehigh Valley Health Network has joined with the University of South Florida to create a novel program to recruit and train medical students. The Dean at USF School of Medicine, Steve Klasko, was formerly head of OB/GYN at the health network. The SELECT program (Scholarly Excellence, Leadership Experiences, Collaborative Training) starts with two years at the USF College of Medicine in Tampa, followed by two years at Lehigh Valley Health Network in Allentown and Bethlehem, Pa. The goal is to train the best physician leaders of tomorrow by combining experiences at tertiary care hospitals, community hospitals and urban health centers in multiple locations. SELECT will thus offer students the opportunity to experience geographically and culturally diverse institutions and patient populations, while advancing their medical and leadership skills. The first SELECT class began in September 2011, and we hope to produce first-rate doctors for all kinds of medical settings, serving rich and poor alike.
Preventing Disease, Promoting Health
When I think about community health, there is no reason to think small. With proper leadership and resources, I believe that the Lehigh Valley could become the “healthiest community in America.” This has been my personal dream for more than 30 years. Reaching this goal would require the combined efforts of Lehigh Valley Health Network, USF Health, The Pool Trust, all other Lehigh Valley health care organizations, local corporations, the school system and other community institutions, along with input from national experts. It would be a huge undertaking, but the benefits for public health would be huge. From an economic perspective, local companies would benefit by attracting employees to such a healthy community.
The effort would include programs to detect and properly treat hypertension, to reduce heart attack and stroke, to provide nutrition programs to promote health and reduce the incidence of diabetes, to make Pap smears widely available to prevent cervical cancer, and to employ mammography wisely to reduce breast cancer. It would include effective smoking cessation programs especially for our youth, immunization for all children, and programs to prevent and manage obesity for both children and adults. The goal would be to provide high-level, prevention-oriented health care for all of our citizens, in the process promoting health as well as conserving financial resources. If successful, the Lehigh Valley could become a model for the nation. I hope we will give it a shot. If he were alive, I know that Leonard Pool would be pleased if we did.
Epilogue: Since starting to write this essay, I have been given the honor to address the second-year students at USF College of Medicine in Tampa, as they graduate from their preclinical to their clinical years, to talk about listening to patients. This will be my first visit to Tampa in more than 20 years.