Permanente physician and wife hazard a hunt in dangerous waters of the Amazon
Editor’s note: Kaiser Permanente physician and educator Martin Shearn and his wife Lori traveled to Brazil in 1973 where Dr. Shearn served as chief of staff for the SS Hope hospital ship docked in Maceio, a poor coastal community in Northeast Brazil. The couple took a few days off from their health care duties to venture into the Amazon River region in September of 1973.
, Guest writer
We’d learned to trust our new young guide on the strenuous and magical jungle hike he’d led earlier in the day. An Indian, Manoel had lived on the Amazon all his life so he knew the rivulets and the inlets as well as the paths where there was terra firma to walk upon.
That night after dinner we embarked in earnest on our highly anticipated alligator hunt. Manoel had caught a jacaré¹ once before, he reported, and he had seen another one near where we’d docked our houseboat. We were extremely excited, bundled up in our canoe, aware of the dangers of the hunt. The mystifying sounds of the myriad of the Amazon’s night creatures made for an eerie scenario.
Just as we got ready to depart, a tremendous upheaval almost tipped the canoe as our cook Milton lowered his huge body into the back of the craft. He insisted his presence was essential to record the event on his brand-new tape recorder. Aliomar, our main guide for the Amazon trip, also came along. We were all in a gay mood, all giggles, as Milton planned (in jest) how he would fix the jacare for breakfast.
We could see Aliomar’s eyes shining with anticipation, for as our guide he wanted us to have a good time. Of course he also was a joyous young man on the hunt for a lark. Manoel, on the other hand, burdened with his responsibility and aware of the dangers, was solemn and quiet, acutely attuned to the sounds of the night. He sat in the front, paddling; Aliomar, Marty and I sat in the middle, and Milton weighted down the back. Manoel carried our weapon: a lengthy stick with a nail-like protrusion at its tip, and we each had a flashlight.
My mind was racing: How big was he?
We were gliding silently over the dark mirror of the river. We soon entered a nearby flooded riverbed (igapó).² We were told to shine our flashlights in slow circles over the surface – on for only a minute, then darkness again – on for a minute, followed by darkness. We could hear whispered conversation between Manoel and Aliomar, then scary sounds presaging all kinds of danger. There were lots of nervous giggles and jokes from each of us and then more silence. Suddenly – shhshhshh – Aliomar seriously hushing us: “I see one!”
Both of the young men became very intent, concentrating on the darkness ahead. Manoel directed their actions. Slowly we crept along the watery thicket, flashlights continually scanning the surface. “Look ahead there,” Manoel whispered. And then I saw two distinct red spots, obviously eyes paralyzed by the light and blinking in terror. It really was an alligator, he was clearly frightened and so were we! My mind was racing: How big was he? What if he lashed out with his tail and overturned the canoe and his family came along to capture us for a meal?
Marty still had not seen the eyes. He had to see them! We shined the flashlights again. Oh yes, there they were. Oh, how exciting! Gingerly, Aliomar maneuvered the canoe closer and closer to the spot. Hardly a sound. Then there was just a small tree between us and the shining red eyes.
When our trepidation subsided, I carefully drew close enough to admire the jacaré and even rub his smooth belly.
We were real hunters now, and while we caught our breath, Manoel kicked off his sandals, stealthily stepped into the water and with his bare hands reached out for our prey. There was a lot of splashing in the brief scuffle, and then, he had him! He held the alligator by the neck, the creature continued to flail his tail and his jaws attempted to snap. Manoel handed the jacaré to Aliomar and they allowed him to snap onto the wooden side of the canoe where he struggled for a while and then began to relax.
When our excitement and trepidation subsided, I carefully drew close enough to admire the jacaré and even rub his smooth belly. His eyes were on alert, but the perfect fingers on his front and back legs were now relaxed. He was resigned to his fate, whatever it was to be. We named him Jose dos Santos and jubilantly brought him back to the big boat.
Overnight, our nervous sleep was punctuated by a dozen giant toads that seemed to croak their disapproval. We were all up early the next morning. The river sparkled like a jewel and Jose was still in the washroom where we’d tied him up before we retired.
While I enjoyed my early morning swim, Milton the cook decided Jose would like a swim also. He made Jose a halter out of rope and dangled him into the water near me. Horrified, I thought Jose was free, and I was not convinced that it was safe to swim in the Amazon with a live alligator.
All through breakfast we bragged like successful hunters of old, recounting our tales of courage. And Milton had it all on audio tape! We played the great adventure over and over. At last the sun was high enough for us to get our photographs – triumphant hunters posing with our vigorously kicking prey, holding him this way and that for better angles.
Finally, we gave him his freedom back. He hesitated when he hit the water, but soon he carefully tested first one arm, then the other, and then with a powerful swish of his tail, he was gone. None of us will ever forget him. Quietly we all hoped he’d swim far enough away that we wouldn’t encounter him, bent on revenge, in our next dip in the mighty Amazon.
Martin summed up our adventure on the Amazon succinctly and excitedly in a September 1973 letter to friends back home:
“Lori and I just returned from an incredible journey on the Amazon replete with piranhas (Lori caught and ate one), lizards, alligators (caught one of those also) and various exotic birds.” (Martin had skipped the piranha experience because he was allergic to fish.)
“The submerged jungle called igapó was the most beautiful (sight we’ve seen). Ever changing and unchallenged. A remarkable experience and all the more so with not a single beer can or other evidence of garbage.”
¹Caiman yacare, jacaré in Portuguese
²Igapó (Portuguese pronunciation: [iɣɐˈpɔ]) is a word used in Brazil for blackwater-flooded Amazonian forests.
How Kaiser Permanente medical center in South
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Lori Shearn and Permanente physician daughter Wendy
recall taking hospitalized kids to circus
Editor’s note: Kaiser Permanente physician and educator Martin Shearn and his wife Lori traveled to Brazil in 1973 where Dr. Shearn served as chief of staff for the SS Hope hospital ship docked in Maceio, a poor coastal community in Northeast Brazil. Their daughter Wendy joined the mission for the summer.
, Guest writer
Sixth in a series
It’s always exciting when the circus comes to town – whether you’re a child in the United States or Brazil.
In Maceio, the circus takes place in a hastily erected tent of particularly poor quality. The canvas is ripped on the sides, and there are many holes in the top, displaying lots of daylight and – in evening performances – moonlight. The costumes are discouragingly frayed. Chairs are placed directly in the dirt. But the expected fabulous antics were all there: Spirits were high. There was a live band and a complicated lighting system that created wonderful bright spots.
There were many talented performers from all around the world, although sitting so very close removed a little of the magic of their make-up. Aerialists performed breathtaking feats on ladders and ropes, hanging by their fingers and toes. The equipment looked so precarious we worried for the performers’ safety.
There were jugglers and clowns and daring motorcycle riders who sped up and around inside a huge cage. So thrilling!
The audience, unexpectedly seemed unresponsive, not cheering or enthusiastic, and there were hardly any children present!
My daughter, Wendy, a volunteer who had joined us in Brazil, suddenly had a brilliant idea: she would bring the children in her hospital play program to the circus!
Making the impossible possible
Wendy established the play program in the small hospital ward and enlisted the help of community volunteers. The sorely needed program gave them the opportunity to participate in the care of these children from the arid, poverty-stricken Northeastern part of the country. The children often stayed in the hospital for months and months, alone and far from family.
Wendy (Shearn, now a physician at Kaiser Permanente) and her fellow volunteers mustered their resourcefulness to make a trip to the circus a reality for the young, sick patients who rarely saw the out of doors aside from the chickens in the hospital courtyard.
First, Wendy had to persuade the circus operators that they would be better off having an enthusiastic group of children in the audience. With that in mind, Wendy thought they might be willing to offer free passes.
Second, the volunteers had to overcome the fact that the kids had no clothes to wear. The nuns at the hospital had the “Sunday” clothes locked away for religious occasions, so they had to be persuaded that the circus qualified as a special event.
Arranging all this took some doing. After all, the children were in the hospital for a reason. They were sick and many were unable to walk or were disabled in other ways.
Big day, big trip to big top
In her own Maceio memoir, Wendy remembers the anticipation and preparation for the trip to the circus:
“The hospital administrators agreed to allow the kids to go, even the eight-year-old boy who couldn’t walk. His excited friends were happy to push him in a baby stroller in the parade to the big top.
“I arrive before lunch to make sure everyone is ready for the trip of the afternoon, and to see what spirits are like. I find that spirits are definitely very high today in the pediatric ward of Santa Casa de Misericordia in Maceio, Brazil.
“The fact that these children are being deprived of so many daily thrills of childhood due to their illness compounds their anticipation. A great event!!
“It has been a week since Maria (a 12-year-old patient with deadly Chagas Disease) pulled me aside and showed me the flag at the very top of the big tent. It was visible from the hospital balcony. Soon she will get to go.
“When I return in the afternoon to pick up the children, a strange mood is settled over the ward. The boys are all in new clean clothes, with hair combed.
“They sit uncomfortably, and hide any excitement in silence. Perhaps they are scared? The girls all look pretty in crinkly dresses that the Irma (Sister Maria) saves for ‘special occasions’.
“Their hair is also nicely combed, excess powder has been sprinkled all over their arms and shoulders, and the girls wear uncomfortable shoes made of wood, with artificial fruits on top. They all smell heavily of baby powder.
“Soon everyone is ready to go, seeming strangely nonchalant about the entire excursion. There are 10 very sick children, and almost as many nurses and assistants, many of whom have brought their own healthy children along. We make a bright spectacle walking along the street on our way to the circus.”
Sights of the outside world of cars and trains and the beach were exciting for the child patients. The gas station attendant noticed the extraordinary procession and gave each child a popsicle to enjoy on the way. They were beaming and when they arrived in the tent the audience – aware of the magnitude of the event – cheered them wildly.
It was probably the most wonderful thing that ever happened to these children.
Wendy concluded in her memoir:
“The circus itself was all any child had hoped for. They laughed at the clowns, especially the deformed little tiny one. They held their breaths at the acrobatics.
“ . . . As we returned the children to the hospital, I felt mixed emotions. The circus had been grand – the children loved it and talked about it with warm smiles the next day. But how sad that the happy times are so rare for these special brave dignified children.”
First black nursing supervisor at Oakland Medical Center:
mentor, pioneer and friend to anyone in need
, Heritage writer
In an era when registered nurses wore starched white frocks, stylized caps indicating their alma mater, white stockings and nun-like white shoes, young Jessie Head (later Cunningham) dreamed of joining the ranks of those she so admired.
Born in 1930 in Ruston, Louisiana, Jessie moved with her African-American family to Oakland, California, when she was four. By the age of seven, she had set her mind to pursue a career as a professional nurse.
Against all odds, in 1951 she succeeded in her quest to enter the then mostly white world of nursing and to forge a highly successful 40-year career as a Kaiser Permanente nurse and nursing supervisor and a tireless community health advocate with the Bay Area Black Nurses Association.
Friends of Jessie Head Cunningham, also known as Mrs. C, Mrs. Ham and Jessie Bea, gathered recently to celebrate her rich life. She died on New Year’s Eve 2013 at the age of 83.
Career delayed by racial discrimination
As Jessie prepared to graduate from Oakland Technical High School in 1948 (famed actor-director Clint Eastwood was in her class), her career counselor told her she should pick another occupation because “coloreds” didn’t go in to nursing.
Undaunted, Jessie set out to get her nursing education. She applied to several schools that rejected her, but she didn’t give up. Biding her time, she enrolled in classes at San Francisco City College and UC Berkeley and continued to apply to nursing schools.
In 1951, Jessie was accepted to the Kaiser Foundation School of Nursing and became one of the first three African-American women to graduate from the school started by industrialist Henry J. Kaiser and his wife Bess in 1947.
A model student and mentor
Jessie was a model student, says Clair Lisker, retired Kaiser Permanente Oakland Medical Center director of nursing and long-time member of the Kaiser Foundation School of Nursing faculty and management staff.
“In those days we would have meetings at my house to discuss patient care and patient education and all kinds of issues,” Clair recalled recently. “Jessie was a part of that. I remember her asking questions and being totally engaged . . . She would always take new students under her wing; she wanted to be sure they got the help they needed.”
Jessie started her in-hospital training at Kaiser Permanente Oakland Medical Center in surgery; her friends say she was always proud when the physicians requested her to assist in the operating room.
One Sunday morning, she was surprised to find her picture in the Oakland Tribune along with her colleagues in surgery. She was wearing a mask, but everyone could recognize her by the distinctive mole on her forehead.
She graduated in 1954 and Sidney Garfield, MD, founding Kaiser Permanente physician, personally handed Jessie her registered nursing degree during ceremonies in Oakland.
After graduation, Jessie decided to focus on OB-GYN nursing and she continued in that field for the rest of her career. In the 1960s, she was the first black nurse to be named supervisor at Oakland Medical Center. She served in that role for 22 years until she retired in 1989.
Also in 1954, Jesse married Robert Cunningham. Son Jeffrey was born in 1955 on the couple’s first anniversary; daughter Robbyn was born in 1957. Sadly, Robert died at a young age in 1979.
Making connections with black colleagues
Dorothy Williams, a nurse anesthetist who started at Kaiser Permanente San Francisco in 1960, met Jessie Cunningham in 1962 when they were both juggling career and family. Coincidentally, Jessie was the nurse assisting when Dorothy gave birth to her second child in Oakland.
Dorothy, originally from Detroit, transferred to Oakland Kaiser Permanente in 1962, and although the two women didn’t work together directly they cemented their friendship. Both earned their bachelor’s degrees in health and nursing administration from Golden Gate University in the early 1980s.
Both were Kaiser Permanente nurses who had found a place where they were valued as professionals despite their race. At the time, opportunities for black nurses were still limited.
So when they heard about the Bay Area Black Nurses Association forming in San Francisco in the late 1960s, they saw an opportunity to help other black women make their way in the profession and ultimately to improve the health condition of the black community.
Jessie and Dorothy dove into the black nurses association’s activities and traveled to many cities across the country attending national conferences after the National Black Nurses Association was founded in 1971. Jessie served two terms each as vice president and treasurer for the Bay Area chapter.
In the local community, they set up health fairs and screening clinics that targeted health problems that especially affected African Americans. Over the years, they were instrumental in conducting community events screening for diabetes, high blood pressure and heart disease and to help people quit smoking.
Black nurses association community programs also took aim against social problems such as domestic violence, child physical and sexual abuse and illiteracy.
‘Do it right’
Jessie was a stickler for professionalism. “She always said: ‘If you going to do it, do it right,’ ” Dorothy Williams recalled. “She believed nurses should be up on their medical knowledge and follow proper procedures.”
Jessie was adamant about the use of the English language. “She detested it when someone spoke (improper) English . . . She would correct people when they mispronounced a word or used incorrect grammar,” Dorothy said.
Friends and colleagues teased Jessie about her strictness with the language. They said she missed her calling and should have been an English teacher.
Williams says Jessie was someone who would always be available to anyone in need. “If you went to Jessie for help, she wouldn’t let you go until your need was taken care of,” she said in a recent interview.
“Jessie was a good person to know. If she was a friend, she was always a friend. She was outspoken . . . she would tell you what she thought, and she would give you advice – in a loving way. But she never deserted her friends, no matter what.”
, Heritage writer
Third in a series marking Black History Month
For David Satcher, MD, all roads lead back to Atlanta where he graduated from medical school 50 years ago. It was there that he adopted the belief that being a black physician meant a lot more than setting up a private practice.
Satcher has had an amazing public health career that has included serving as the U.S. surgeon general during both the Bill Clinton and George W. Bush administrations, and simultaneously as assistant secretary of health at the U.S. Department of Health and Human Services.
He also has served as director of the Centers for Disease Control and Prevention, president of Mehary Medical School in Nashville, president of Morehouse Medical School in Atlanta, and in many other leadership roles in academic medicine and public health.
Today, he brings his many and varied experiences back to his Atlanta alma mater, where he heads the Satcher Health Leadership Institute at the Morehouse School of Medicine.
Kaiser Permanente is a major supporter of Satcher’s institute and contributed a total of $800,000 in Community Benefit grants in 2009 and 2011.
Kaiser Permanente’s decades-long mission—providing preventive care, promoting healthy lifestyles and working to eliminate disparities in health care —dovetails beautifully with Satcher’s initiatives over his long career.
While surgeon general from 1998 to 2002, Satcher adopted what he called “Prescription for Healthy Living”:
- 30 minutes of moderate exercise at least five times a week
- 5 servings of fruits and vegetables a day
- Avoidance of toxins – drugs and alcohol
- Responsible sexual behavior
- Daily participation in relaxing and stress-reducing activities.
A constant warrior for eliminating disparities in health care, Satcher founded the leadership institute in 2006 to train health care leaders intensively to bring new, inspired energy to the battle for parity in health care.
He takes a quote from civil rights leader Martin Luther King, Jr., as the Satcher Health Leadership Institute’s mantra:
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Satcher has not been afraid to push for ways to improve the health of everyone, with special emphasis on breaking down barriers for minorities essentially locked out of the health system by financial constraints.
Pushing for unfettered education and realism to promote sexual health, Satcher has bumped into controversy along the way. He has also been a strong proponent of reaching the mentally ill population through primary care and preventive services.
Satcher grew up in an environment that did not treat African-Americans as full-fledged citizens: when he was 2 and deathly ill with whooping cough and pneumonia in Anniston, Alabama, his only hope — because of hospital segregation— was the one black doctor who came out to the family’s farmhouse to treat him.
“Dr. (Fred) Jackson told my parents he didn’t expect I would live out the week,” Satcher related. “But my mother refused to give up. She stayed up with me all night, my older sister told me, and breathed for me when I couldn’t on my own.”
As a young child, Satcher heard of the near-death drama many times: “My mother never let me forget it!” he recalled with a laugh. As a result, Satcher vowed at age 5 or 6 that he was going to be a doctor just like Dr. Jackson.
“I had no idea what it was going to take to get there, but I was as certain as anything in my life that I would,” he said.
In 2013, the University of California at Berkeley honored Dr. Satcher with its Public Health Hero award, along with J. Michael McGinnis, MD, senior scholar at the Institute of Medicine, who has worked with four U.S. Surgeon Generals in his career.
Raymond Baxter, PhD, Kaiser Permanente’s national senior vice president for Community Benefit, Research and Health Policy and a longtime friend of Satcher, presented the award to Satcher, noting the honoree’s vast contributions to public health over his long career.
Earlier the same day, Satcher met with Kaiser Permanente leaders and presented his core concepts on leadership. He applauded Kaiser Permanente for its vision for Total Health and for its rich history in primary care and prevention.
In accepting the award, Satcher said he was a “debtor” who owed his success to many people who contributed to his life. He said “Public Health Hero” with the relish of someone who had to pinch himself to believe the honor was his.
Satcher called out the person to whom he is most indebted: Anna Curry, his mother. “I dedicated the entire year of 2013 to Anna Curry. She was born 100 years ago on Feb. 28, 2013.
“She was the 16th of 17 children and she was to have 10 children of her own. My parents never finished elementary school. . . . When I got sick, she had just lost one child and she wasn’t going to let another one go.
“If it wasn’t for her I would never have made it out of childhood.”
By Steve Gilford
Senior consulting historian
As an independent historian with a long-standing interest in Kaiser Permanente, I was fortunate to be invited to the daylong 60th anniversary celebration of the Southern California Permanente Medical Group, held recently in Anaheim, Calif.
The event was to mark the medical group’s formal start in 1953 when 13 Permanente physicians, including Ray Kay, the first medical director, signed a partnership agreement that officially formed SCPMG.
The group’s origin actually goes back to 1943 when Henry J. Kaiser asked Permanente co-founder Sidney Garfield, MD, to establish a health care plan for workers of the Kaiser Steel mill in Fontana.
Today, SCPMG has more than 6,000 physicians practicing in 14 accredited Kaiser Foundation Hospitals and more than 190 medical office buildings.
Pride a theme of celebration
As I observed the events of the day (Sept. 28, 2013), I heard Permanente physicians express pride in the organization and its legacy. But at first I wasn’t entirely sure the expressions were genuine, or if it was similar to the type of pride shown for a football team or one’s alma mater.
As the day unfolded, it became increasingly clear that this was an authentic professional pride rooted in SCPMG’s 60-year history of trials and triumphs.
Pride in the organization can be traced back even further, to the tiny 12-bed hospital Sidney Garfield built in 1933 on a parched and lonely piece of desert land in one of the most physically inhospitable places in the United States.
The organization that sprang from that little frame building in the Mojave Desert, with its one doctor and one nurse, was being celebrated by thousands gathered together in one of the most populous and powerful metropolises of the nation.
Roll call gets vociferous response
Edward Ellison, MD, the SCPMG executive medical director, began the day by calling the roll of Southern California’s medical centers represented at the gathering. Each medical center team responded to the call with a spontaneous cheer that resonated across the large hall.
There was no question that these physicians were enthusiastic, but it was not yet clear to me just why they were responding with such vigor. Was it like the way people in a talk-show studio audience react when someone mentions their hometown?
Was it just because they had found a comfortable place to practice medicine outside the increasingly stormy arena of fee-for-service medicine, relieved to be insulated from some of the stresses their professional colleagues were facing?
Or was it truly because they were recognizing that they were a part of an organization that was truly special, with a leadership that encouraged them to practice preventive care and to take great care of their healthy members, as well as their sick patients?
Celebrities tout Permanente’s national role
As a part of the proceedings, there were dramatizations featuring Henry Kaiser, Sidney Garfield and even Rosie the Riveter – all well done and entertaining. They set the stage for Kevin Starr, noted California historian and author, and Nancy Snyderman, MD, chief medical editor, NBC News, and award-winning journalist.
The celebrities’ presentations put the achievements of Kaiser Permanente into perspective, each emphasizing the contribution of the organization to the nation’s health care.
Starr and Snyderman were the stars of the day, but for me the day’s high point was an onstage discussion by the four surviving SCPMG executive medical directors – Frank Murray, MD, 1982-1993, Oliver Goldsmith, MD, 1994- 2004, Jeffrey Weisz, MD, 2004-2011, and Edward Ellison, MD, current executive director.
They presented the organizational challenges that they had faced in their time and told how they had overcome them.
Through all their recollections flowed a strong streak of natural idealism that had helped them shape their responses to the challenges of their time at the helm. Their remarks – more than any other presentation – made it clear that SCPMG leaders created and passed on a strong legacy that was to be treasured, defended and enhanced.
As the day drew to a close, Dr. Ellison summed up what he felt was special about Permanente Medicine and SCPMG. “We are building infrastructure for the future . . . I am confident that our approach to achieving the total health of our patients in mind, body and spirit is the successful path to that future.
“Our conquering, enduring spirit, combined with our passion for medicine and our caring from the heart, will sustain us for the next 60 years,” he told the group.
Often, when you hear such presentations made by leaders in front of their staffs, if you listen carefully you can hear quiet undertones of mildly cynical scoffing or snickering from the rank and file who may have a quite different perspective on the relation between idealism and reality.
That afternoon I was listening closely for that tell-tale buzz from among the 3,000 people in the hall. I didn’t hear it.
What I did hear was enthusiastic agreement with what Dr. Ellison was saying. I understood then that the pride I had sensed in the responses to his morning roll call of the medical centers had been genuine and had only been enhanced by the day’s focus on the achievements and potential of Permanente Medicine.
I left Anaheim with a renewed sense of pride in my association with Kaiser Permanente, for my modest part in searching out, saving and communicating its history to new generations of physicians who will preserve and expand the legacy begun by its founders.
By Ginny McPartland, Heritage writer
Second of a series
Forty years ago, before advanced nursing positions existed, a group of Kaiser Permanente nurses were cutting their teeth in new fields as specially trained nurse practitioners. In the beginning of this journey, these nurses worked in preventive medicine, well baby care and OB-GYN.
Dorola Haley began work with OB-GYN physician Albert Kahane when Kaiser Permanente first opened in Sacramento in 1965. Around 1970, Dr. Kahane received a Kaiser Foundation Research Institute grant to study the role of the nurse practitioner in OB-GYN practice. At the same time, Haley completed the requirements to become a nurse practitioner, and soon she and Dr. Kahane began to take turns seeing patients.
Dr. Kahane was the first in Sacramento County to propose the then-radical idea of fathers in the delivery room. Haley says there was a lot of resistance to this in the medical community, but he believed it to be beneficial for the family and was proven right.
“They wanted to run Al out of town on a rail,” Haley said. (OB-GYN physician Sidney Sharzer pioneered this in Kaiser Permanente in Southern California.)
Dr. Kahane felt that couples would find another way to be together during childbirth if hospitals didn’t modernize. He had been in the U.S. Air Force for four years in Alaska, where this was established practice.
More time to get to know patients
At a recent reunion, several of the early Sacramento NPs talked about how the extra time they spent with patients – a full, uninterrupted 30 minutes – was crucial to the member’s total health. Busy physicians could only rarely devote this much time to a single patient. The NPs’ stories are about striving to reach the ideals of preventive medicine, about getting to know the “whole” patient, and helping him or her to maintain good health.
“We knew our patients’ social history,” said Dianna Costa, an OB-GYN nurse practitioner still working part time for Kaiser Permanente today. “We knew whether the family had a dog, and if they did, who fed the dog. We knew what you (the patient) were eating, and if you exercised. In a 30-minute physical you learn it all. It (preventive care) was huge to us. It was life, not just a physical.”
“If you listen to a patient, really listen, you learn everything you need to know,” remarked Haley. “I’d ask them to tell me what’s going on. For prenatal patients, I’d talk to them about what’s going to happen in the next month.”
Nurse practitioner pioneers praise mentors
Carl Henriques, MD, medical director of the Sacramento Preventive Medicine program, now deceased, was ruthlessly strict in expecting his students to conduct physical examinations and medical histories perfectly. “You could say he was a tough task-master,” recalled Betty Taisch, one of the pioneer NPs.
Taisch recently attended a lecture by Abraham Verghese, MD, author of “Cutting for Stone,” a current best-selling novel. The Stanford University School of Medicine professor described the importance of caregiver-patient trust and rapport – and of touch. “You walk into a room and someone is sitting there with only a piece of paper covering them, and you ask them the most intimate questions,” noted Taisch.
“You have to quickly develop a bond of trust with this person. You have to understand the simple art of putting your hand on their shoulder. As I was listening to him (Dr. Verghese) describe his bedside manner, I was sitting there so proud because I recalled being taught exactly the same things by Dr. Henriques,” Taisch said.
Marge Geary, a nurse practitioner pioneer and health appraisal manager from 1978-1984, chimed in: “The way he taught us was systematic, so that we didn’t miss anything.” Dr. Henriques began all of his progress reports on student Marge Geary in 1972 with “This young lady . . .” Today she is both the assistant medical group administrator and director of nursing practice at Kaiser Permanente South Sacramento.
The early NPs have nothing but praise for Millie Kahane as well. They say she helped them reach for a higher level of professionalism through education and training. “She took a broad view of everything,” Geary recalled.
John Mott, MD, physician-in-chief at Sacramento Kaiser Permanente, summed up the experiment: “(In 1970) the medical climate for NPs was quite different than it is now. The status of the nurse practitioner was not clarified by the California Legislature until 1975.
“Had Dr. Henriques and Mildred Kahane, (BS, MA), slipped, the stature of NPs in California could have been delayed many years. Such are the dangers of living very close to the State Legislature, the Board of Nursing, the Board of Medical Examiners and the Attorney General. . . . (KP) Sacramento membership includes many articulate, highly educated, health-oriented groups . . . who might or might not approve of being examined by a nurse practitioner (rather than a physician).
“Credit should go where credit is due, and Dr. Henriques and Mildred Kahane did a tremendous job pioneering this field.”
By Ginny McPartland
First of a series
It’s 1970 and Kaiser Foundation Health Plan’s operation in Sacramento is just five years old. The state of California and the federal government have both recently set up health benefits for their employees with Kaiser Permanente as a popular option.
The Northern California Health Plan is quickly approaching its million members mark, and the Sacramento facility is overflowing with patients.
Meanwhile, Mildred “Millie” Kahane, BS, MS, a New York transplant teaching nursing at California State University, Sacramento, thinks her students are bright enough to contribute more in the burgeoning field of health care. The destiny of nurses, she believes, is to rise above the traditional hospital bedside role and to take on more responsibility in an outpatient setting.
She believes her students can learn new skills that could eventually be included in a bachelor of science nursing program and that these advanced nursing capabilities would provide the core content upon which to build clinical specialties.
John Mott, MD, physician-in-chief at Kaiser Permanente Sacramento, is facing increasing pressure to welcome and serve new members. His resources for providing primary care and new member health assessments can’t keep up with the demand. What is he to do?
Fortuitously, Mott and Mrs. Kahane have occasion to meet – through her husband Kaiser Permanente Sacramento chief of OB-GYN Albert Kahane – and their collaboration sets in motion a revolutionary program to elevate the nursing role and to solve Mott’s shortage of primary care providers.
Some of Millie Kahane’s students will become “nurse practitioners,” a title unheard of at the time in Sacramento County, and Kaiser Permanente members will get comprehensive evaluations in what will become known as the Department of Preventive Medicine.
Origin of advanced practice nursing
The story of Mrs. Kahane and her hand-picked nurse practitioner pioneers was not unique in the 1970s health care landscape. Indeed, medical providers throughout the United States were looking for solutions to a manpower shortage. In that era, the federal government provided special funding to identify ways to maximize health care dollars.
Within Kaiser Permanente in particular, physicians in Southern California, Oregon and Hawaii began to train nurses to examine seemingly well patients and identify any abnormalities for follow up with a physician.
Pediatrician Sam Sapin, MD, in Panorama City worked with Southern California Permanente Medical Group Director Raymond Kay, MD, to train nurse practitioners to provide well-child check-ups, along with physicians.
In Oakland in the early 1970s, Drs. Morris Collen and Robert Feldman employed NPs in the “Multiphasic,” an annual physical program originally set up for the longshoremen’s union in 1951.
After nurse practitioner programs were well established in Northern California, The Permanente Medical Group developed a certification process for those who were to work as nurse practitioners within the organization. This process later helped Kaiser Permanente nurses meet California nurse practitioner requirements.
The first formally educated Kaiser Permanente nurse practitioner was Linda Lee, who was one of Mrs. Kahane’s students at Sacramento State. Upon graduation, she attended the nurse practitioner program established by Henry Silver, MD, at the University of Colorado in 1965.
Silver’s program was the first university-based pediatric nurse practitioner program in the United States. After completing the program, Lee came back to California and worked with Sacramento Kaiser Permanente Chief of Pediatrics Clifford Skinner, MD.
Synergistic forces converge in Sacramento
Why is the story of the Sacramento Kaiser Permanente Nurse Practitioner and Preventive Medicine Program of the 1970s remarkable? Looking back after 40 years, the program’s pioneers – many still working for Kaiser Permanente – marvel at the phenomenon of a close-knit group of advanced practice nurses who loved their mentors and their patients and whose lives were marked indelibly by the experience.
Nurse educator Mildred Kahane and Physician-in-Chief John Mott’s alliance to develop a nurse practitioner program found fertile ground in the hearts and minds of certain of Mrs. Kahane’s graduates. In 1970, Mrs. Kahane set completion of a bachelor of science degree as the basic program requirement and recruited four candidates to begin work (and training) in the Health Appraisal Evaluation center to be located in an older Kaiser Permanente building at 3240 Arden Way, Sacramento.
Kaiser Permanente allergist Carl Henriques, MD, formerly a general practitioner in Susanville, Calif., became the center’s physician leader and primary teacher. As the program progressed, the University of California at Davis Medical School was developing a mid-level practitioner master’s in Health Services program for nurses.
UCD lacked clinical facilities, which Kaiser Permanente had. Eventually KP and UC partnered, and UC students were able to enhance their clinical experiences at Kaiser Permanente with Mrs. Kahane and Dr. Henriques as members of the UC clinical faculty. Kaiser Permanente nurses were given the opportunity to apply their education and training toward the master’s degree.
Next time: Kaiser Permanente preventive care patients benefit from more time with their provider.
This blog is dedicated to the memory of Eileen O’Hagan McCauley and Linda Lee (both deceased), two of the first NPs at KP Sacramento, and the late Carl Henriques, MD.