Dear Carolina Colleagues: Welcome aboard the second Tar Heel Bus Tour—Thus began an introductory letter from Chancellor Michael Hooker regarding a week-long tour designed to provide new faculty insight into what North Carolina holds and how the University fits into the state. We were 32 new faculty graduate and undergraduate, experienced and newly-minted, deans and librarians. The chancellor acted as host, tour guide, facilitator, and dinner partner. On a personal level, it gave me an opportunity to step back from a hectic medical school life and learn something about what makes this state so great. As one of three medical school faculty members and of only a handful of scientists, I resolved to consider how the Medical School and the state can further benefit from each other. (See www.unc.edu/bustour/news.html)

We first stopped at Ft. Bragg, where Captain Bradley Hall briefed us on the military applications of technology and about the military’s economic impact on the state. Our briefing included a discussion of technological advances for warfare which have recently been adapted toward surgical interventions. Adaptations include endoscopic and laparoscopic surgery, telemedicine, and noninvasive procedures. Except for military grants, there is no direct interaction between Ft. Bragg’s Womack Army Hospital and the UNC School of Medicine. As we lack an engineering school within our University, it may benefit us to further link ourselves with Ft. Bragg.

We ended our Ft. Bragg tour with a jump from the parachute tower. A number of school children were there that day, and they jumped without hesitation. I was humbled by the daring of the children as I took my leap of faith. The Chancellor jumped twice.

We moved on to UNC at Pembroke, where we attended a discussion of the Lumbee Indian presence in the area and in the state. The Lumbee are very proud of their heritage and have learned quite a bit during their struggles for federal recognition. Pembroke has become a center for tribal education, through higher education and through outreach programs in the local schools. Limited interaction with the rest of the state can lead to fear; now I better understand some of the wide-eyed and skeptical looks I receive from some Lumbee patients. A specific outreach from the medical community toward the folks in Lumberton would provide familiar faces and surroundings for them when they come to Chapel Hill for any kind of care or treatment.

Moving on the road towards the coast, we had dinner in little Washington, home of the North Carolina Estuarium, an aquarium that focuses on areas where salt and fresh water mix. There are huge areas within North Carolina’s sounds which have their own unique ecosystems. The study of pfisteria as a cause of massive fish kills in these areas provides a paradigm for how agriculture, economics, science, and medicine need to meet in order to solve various ecological problems.

The next day at the Hope Plantation we met a number of volunteers for the North Carolina Breast Cancer Screening Program. Lay health advisors discuss breast cancer and bring it out into the open among the women in eastern North Carolina. Their slogan "Health is Wealth" aims to increase general understanding of health as a priority. While the program was started for breast cancer screening, secondary gains include routine physical exams for previously untrusting women and a stronger social consciousness. Dr. Joanne Earp is principal investigator of the project, but the real workhorses include the community outreach specialists. The program is a model for volunteerism and for health care screening problems in any area of the country, particularly those underserved due to poor funding or a poor educational base.

At the Nags Head Wood Preserve we got a glimpse of the biodiversity in the coastal waters. A slide show told why the Outer Banks has the best fishing on the east coast, as well as why hurricanes are most likely strike land there. UNC’s influence extended to our exposure to The Lost Colony outdoor drama, developed by faculty member Paul Green in the early 1930’s and still playing on Roanoke Island today.

The next morning we were off to Somerset Place in Washington County, a plantation which UNC archaeologists and anthropologists are studying to determine and restore its 18th and 19th century condition. Interestingly, colonial owner Josh Collins recognized that the health of his slaves determined the financial health of his plantation. Although tribal medicines were theoretically forbidden on the plantation, physicians of those days looked the other way when patients attempted to revive their traditions.

Throughout our travels, it was apparent to me that eastern North Carolina is probably the poorest and most underserved part of the state. Many of our patients are educationally deprived and financially strapped. It is clear that they depend on the Medical School to keep them healthy.

We moved on to Raleigh for a round table discussion of environmental policy in our state. It became apparent during this meeting, as on other stops, that science and technology will drive much of our state’s growth and development, and that the educational system needs to increase our citizens’ understanding of technology. As physicians, we are in a unique position in our communities to help teach about science and to make it exciting. We can provide drop-in lectures for students and more detailed seminars for teachers. Dr. Michael Zenn in our Department of Surgery has done just that with his "Saving Face" program, which educates high school students on the dangers of smoking and sun exposure.

Our next stop in Siler City highlighted our Hispanic intercultural diversity. Like many North Carolina towns, Siler City’s population has doubled in the past five years, and most of the new residents are Hispanic immigrants. Next year it is predicted that 60% of their kindergarten class will be Spanish-speaking. The teacher population is not prepared for this bilingual education, and these students’ parents often do not speak enough English to help them with their homework. The Hospital and Medical School need to increase publications and information for Hispanic patients, as well as help the hospital workforce to better deal with this growing population. We cannot provide a high-level of care to any population unless we understand its language and culture.

As we travelled nearer the mountains, the air became a bit cooler and the water ran a bit clearer. We visited a potter’s shop, a furniture factory, and a textile mill. Clearly computerization is changing the way they do things—from CAD laser carving of furniture to the almost complete replacement of manual labor with robots in the textile mill. Even the potter’s son, Jason Luck, is studying computer science and mathematics at UNC, while planning to be the 6th generation potter in his family.

Our final stop at Grandfather Mountain was entertaining, as we met the owner, who provided his own insightful and photographic glance into the history of UNC and the history of the mountains. Acid rain is certainly impacting this area of the state, and we will lose a precious resource if the problem is not addressed in the near future.

The Tar Heel Tour left me with the impression that our state not only covers a large area but a large variation in ecology and culture. Despite this breadth, it is a comfortable and cozy state, mostly because the people have always been connected by various institutions—first the plantations, then county and state politics, and most recently, the University. North Carolinians really do identify the University as their own and are genuinely proud of it. The University is an excellent resource for many people and its impact is enhanced by outreach programs such as the Breast Cancer Research Program and even the Tar Heel Bus Tour. As physicians, we can help the state adapt to the 21st century by acting as a scientific resource for our communities.

The Medical School and Hospital have a responsibility to provide excellent care for our patients, and this includes making them feel welcome and comfortable when they come to Chapel Hill. Tar Heels identify themselves by the county they are from. We can use this information when decorating the new Children’s Hospital by dedicating patient rooms to each county or by decorating them with artwork from around the state. Children would be more comfortable when they entered the Hospital if they saw something they could identify with. The Hospital also might consider a specific outreach to the Lumbee Indians as well as creating programs similar to the Eastern Carolina Health liaisons.

I really enjoyed meeting faculty from other disciplines and found Tar Heels to be creative, energetic, and friendly. Next time I am out on the road I will be sure to ask people how things are in their neck of the state and will let them know that I work in Their University.

From Surgery Quarterly (Dept of Surgery newsletter)
Julie Allred, editor
966-5303
allred2@med.unc.edu