ACPM 2013: Day 2

Today was a lighter day than yesterday, mostly because I didn't want to go to the all-afternoon session on reducing childhood obesity among Latino children in Arizona (crazy, I know, since that's usually my area of interest in tropical medicine...).

The day started with a 4ish mile trail run, starting at 6am. As I joked to my former program director (also running), I don't know who did the risk assessment for that exercise, but whoever it was should clearly be fired. Running on trails before the sun comes up (and in the cold--I think it was about 38 this morning) was not a very good idea. We did get to watch the sunrise over the mountains as we ran, though, which is always one of my favorite sights.

Once we had breakfast and got cleaned up, it was time for the first plenary session, which I think was misadvertised. The lecture was called Population Health, but I kept waiting for him to stop talking about primary care and start talking about population health, which he never really did. The second session was equally disappointing. It was about vaccine updates, which last year was a very good talk, going into all of the recommended changes to the vaccines and vaccine schedules from the CDC and why they made those changes. Maybe there just weren't very many changes and they had to fill the time with something else; I don't know.

After that was my break in the afternoon (see above comments about not going to the thing about obese children), which I used to fill out questionnaires and quizzes to get credit for the hours I'm here. Then we had the last session, which was about the future of preventive medicine. They had some interesting ideas, but none of them were all that applicable to preventive medicine in the Army.

Tomorrow's my presentation, so I hope I'm prepared!

ACPM 2013, Day 1

Yesterday I flew into Phoenix, Arizona for the American College of Preventive Conference. Sadly, with all of the budget stuff that's going on in Congress right now, the Army doesn't have the money to pay for me to attend, but since it is my specialty's conference, and I'm presenting on Saturday, I forked over my own money to come. And it's ACPM, which I've been attending since I was a med student.

The day started with hitting an overcrowded gym (preventive medicine types like exercising) before I grabbed breakfast and hit the registration table, getting my first-ever "ACPM Member" badge (instead of Med Student Section or Resident Physician Member badge). The opening plenary speaker today, the editor-in-chief of the American Journal of Preventive Medicine, talked about the health care system (a popular topic at these meetings). Specifically, he talked about the fact that it isn't a system; it's a bunch of people doing whatever they want and ignoring the other pieces of the puzzle. He compared it a construction company that built houses by telling everyone to do what they usually do and giving nobody blueprints, which I thought was an interesting (but probably apt) comparison. These kinds of fractures, in his opinion, are what is driving up the cost of healthcare so much in this country, and changes that we're making (like Obamacare) are the same as rearranging the deck chairs on the Titanic while it's sinking. He said we need to be more like engineers, who actually think about systems as a whole, and if we did that, we would not only be more efficient (and therefore cost-efficient) at providing healthcare, but better at it, too.

The next session I went to I fully expected to be bored during. It was titled: "Linking Primary Care and Public Health: Where Are We?" I expected it to be about lifestyle medicine--talking to people about what they eat and how they need to exercise. I was pleasantly surprised to find that it was more about how primary care uses what we find in public health to do primary care better. One speaker, the health commissioner for Georgia, used the example of infant mortality, which was much higher in Georgia that most other states. They looked into what was causing infant mortality in Georgia and elsewhere, found out how to impact the most common causes, and implemented them. As a result, infant mortality dropped.

I think my favorite session today was the keynote speaker, former U.S. Surgeon General Richard Carmona, who was Surgeon General from 2002-2006. He talked about the plague of politics on science and medicine and how whenever politics gets involved in science, everyone loses. He used specific examples, both from his own term as Surgeon General, such as fighting with the Bush administration about how abstinence only sex education has no science behind it because it doesn't work, and older examples, going all the way back to the bubonic plague outbreak in San Francisco at the turn of the twentieth century, when the public health commissioner of San Francisco (or California, I'm not sure) wanted to quarantine ships coming into harbor, and the state of California disagreed because they thought it would ruin tourism and trade. That one went all the way up to the president, who sided with the medical people, which led to the end of the outbreak. The point that he really drove home is that, while the Surgeon General is a political appointee, he can't be the physician of the president or the party that put him into office; he has to be the physician of the United States, and to do that, he has to follow only the science, and not the politics that tries to get involved in it. He was an amazing speaker and brought the entire audience to our feet when he was done.

After a few more sessions in the afternoon, we had the med student/resident/young physician happy hour, which was "light appetizers" (which I ate enough of to count as a full dinner) and then preventive medicine trivia, which my team won. I even got a prize: MRSA and a CDC mug. I don't know why the picture is sideways.

ACPM 2012

I spent Tuesday through Sunday in Orlando for the 2012 conference of the American College of Preventive Medicine, which has been a combination of a lot of fun and a lot of work (well, as much work as sitting in rooms in a conference center is).

The conference started on Wednesday (Tuesday was just a travel day) with a session on health economics and cost-effective analyses (yes, it was as exciting as it sounds). Thursday was a very long day, with a run in the morning before breakfast (a little more than 4 miles through Downtown Disney and surrounding areas), followed by sessions all day, poster presentation in the evening, and one more session that ended at 9:30. Long day. Here's a (not great) picture of my poster:

Friday was a slightly shorter day, mostly because I didn't see anything interesting to go to for one of the sessions and I decided to take a nap instead. The day also ended earlier, with the last session ending at 4:30 and my fellow residents and I deciding to go out to Universal City Walk for dinner afterwards. There were some big-name restaurants there, but it being a Friday night, the wait at some was rather ridiculous. We tried to go to Emeril's, but when they told us it was a 2-2.5 hour wait, we decided to hit Hard Rock Cafe instead. And because it was Hard Rock, we went to the store, where Derek decided to model the merchandise:

Saturday morning started with a long run, again through Downtown Disney and around the golf course. I actually got lost around the golf course, which made for a nice run, and amazingly enough, I made it back to the hotel with almost exactly the right mileage for the run (six miles). Here was my course:

Most of the sessions on Saturday (at least, most I attended) were part of the Uniformed Service Academy of Preventive Medicine offerings, which included a business meeting (terribly exciting), followed by a session on measuring behavioral health in the Army, then a session on vaccine surveillance in the military. In the evening was the awards banquet, which was a dress-up event. Derek and Raul only kinda understand the concept of dressing up:

Derek ended up getting an award for his oral presentation on degenerative disc disease, so we're very proud of him.

In all, it was a good conference, and I hope that next year I'm not too busy with work to go again.

Last day of the ACPM conference

Today was the final day of ACPM 2009, which was a bit sad. It was fun hanging out with medical students and doctors who have the same feelings on medical careers as I do (even if they are all bleeding-heart liberals who think that Obama is the savior of the known universe). Anyway, here's a brief run-down of the day (and I'll try to explain acronyms and abbreviations better):

1) One last breakfast with the MSS (Medical Student Section)

2) Listening to the explanation of Healthy Americans 2020, which is a repackaging of Healthy Americans 2010. Nothing's really changed. Pretty boring session.

3) Argued with some administrators/test-writers of the USMLE (United States Medical Licensing Exam; the Board exams) about public health and preventive medicine questions in the multiple-choice and standardized-patient portions of the exam. LTC (Lieutenant Colonel) Cavicchia (one of the OSU alums in preventive medicine) was taking my side, so I guess I wasn't too far off.

4) Lunch (not that exciting)

5) Great careers in preventive medicine-public sector session. This is where the CDC, Army docs, and state/county public health directors talked about their careers. Some of them were pretty impressive. CPT (Captain) Ahluwalia and I were essentially planning out the timelines of our careers (when he would take over from the current Army director at the Global Emerging Infections System and when I would take over from him, etc). I hope it works out that way!

6) Preventive Medicine challenges in Iraq and Afghanistan session. Needless to say, this one was geared toward the Uniformed Services Academy of Preventive Medicine (of which I am the lowest ranked member!)

7) Wrote a speech at the last minute for the awards banquet, and then gave it in front of all these impressive preventive medicine physicians, including my future residency director. Well, they said I did a good job, so I guess that's all that matters. And no, I didn't win an award, I was giving them--I was announcing the winners of the Future Leaders in Preventive Medicine grant, which is what paid for the other medical students to come (I was paid for by being a med student section officer).

Anyway, tomorrow morning it's off to the airport to try to get on an earlier flight on standby. Either way, I'll be home tomorrow.

Update from the ACPM conference

So I was going to write about significant events for each day of the ACPM (American College of Preventive Medicine) conference, but I got too lazy. Here's significant events of the first two days:

1) Met my new residency director. LTC Cersovsky, the current WRAIR residency director, will be getting promoted (as happens in the Army) sometime this year, so MAJ Mancuso will be taking over. I got to meet him, and everyone who has worked with him says he's a really nice guy and very smart, so that'll be a good experience.

2) Met another OSU alum in Army preventive medicine. MAJ Schnabel is a 2002 OSU College of Medicine alum who is currently the director of the Global Emerging Infection Surveillance at the Army's research facility in Kenya. He has done some pretty exciting things with disease surveillance in Africa, which really makes me want to have his job someday. He now makes five OSU alums/future alums I know in preventive medicine in the Army (one resident at Madigan, one resident at WRAIR, a staff member at WRAIR, him, and me). Pretty impressive for a school that doesn't emphasize preventive medicine in the curriculum at all.

3) Impressed the MSS (Medical Student Section). We had our annual MSS meeting this morning, and the members who were there seemed rather impressed with stories from PNG. One of the girls had done some public health work in Tanzania and also sees herself doing a lot of international medicine in her career, so we had a very long talk about that while socializing tonight.

4) Discovered that I get to add another publication to my CV. The project I worked with at WRAIR during my preventive medicine month has been made into a poster (CPT Ahluwalia, the resident--and OSU alum--I worked with that month will be presenting).

5) Been invited to join in another research project. Another WRAIR resident (CPT Manos) invited me to join in a project that involved WRAMC interns (of which I will be next year). It'll probably lead to a publication in a few years.

6) Been welcomed to the RPS (Resident Physician Section). CPT Ahluwalia is the RPS president, and I think he's grooming me to follow in his footsteps (being as I'm a fellow WRAIR Buckeye and all), so he's been taking care of me during the conference and talked me into coming to the RPS meeting and is trying to get me to run for an officer position (as an intern!). He's also been trying to convince me to go to Johns Hopkins for my MPH, which is what he did.

7) Networking, networking, networking! I'm meeting so many interesting people with very interesting careers in the field, and I'm getting very excited about the possible things that I can do, both in the military and if I decide to leave when my commitment is up (in eight years).

So far, it's a really great conference, and I'm looking forward to learning more tomorrow. As for now, it's time for bed.

The never-ending day

Wednesday, February 11 began at 5:15am in Port Moresby, Papua New Guinea. After a quick shower and packing everything that didn't get packed the night before, I helped myself to breakfast and checked my email again before getting in the taxi at 7am, headed for the airport. Check-in went rather smoothly, although we discovered that my itinerary required me to get an Australian visa (which they were able to handle at the POM airport), and I found myself with some time to kill before my 9:40 flight (which left at 10). I occupied some of that time by buying a six-pack of South Pacific beer for the brothers as a souvenir at the duty-free. Unfortunately, they'll never get it—it was confiscated by customs in Sydney. I guess it's the thought that counts, right?

It was an uneventful (thankfully!) flight from POM to Brisbane, and then I grabbed my bag, went through customs, checked my bag in again for a domestic flight to Sydney, took the train to the domestic terminal, and had just enough time to buy a bottle of water before boarding the plane to Sydney. Then in Sydney it was another transfer from the domestic to international terminals before it was time to go through customs again (this time for departing Australia). This layover was a little longer, which gave me time to peruse the duty-free in Australia (I bought crocodile and kangaroo jerky to replace the confiscated beer) before hopping on a nine hour flight from Sydney to Honolulu, most of which I slept through (thankfully).

I was awake for the last two or three hours, which gave me time to start reading a book I bought at the Sydney airport called A Doctor's War, by Rowley Richards, a former Australian Regimental Medical Officer who was captured in Malaysia during the Second World War; the book is from his diaries of his time spent in the POW camp. I'm not done with it yet, but so far, it's an amazing book, right up there with A Surgeon In Combat by an American Army battalion surgeon in Europe during this same period. Many of the things Dr. Richards writes about I have experienced myself as a young, future medical officer in the Army in a time of war. One thing that really rang true to me is his descriptions about his excitement about seeing combat, which in the wisdom of his older years (after having been a POW) he scoffs at as youthful ignorance. I will admit, I have experienced the same anticipation about deployment, which I am sure will happen, it is just a matter of when and where. I know it is youthful ignorance, and I know that my preconceptions about what the life of a doctor is like in a combat zone are probably 90% false, but those feelings are still there, and I am sure that someday, like Dr. Richards, I will look back and wonder why I looked forward (if that is even the right term to describe it) to being deployed. Still, what I have read so far is very powerful, and I'm very impressed with what Dr. Richards went through and how he managed to continue working as a RMO during his time as a POW. And all of that was in the tropics, so he was dealing with things like malaria and dengue fever and tropical ulcers, most of the time without any medications (the Japanese confiscated their medicines); he wrote about applying good hygiene and preventive measures in a time when such ideas weren't popular at all. He's now a preventive and occupational medicine physician (well, he's now semi-retired, but he was a preventive/occupational medicine physician), so there's another reason for me to look up to him. I hope if I'm ever in conditions half as bad as he faced that I can show the same initiative and integrity that he writes about.

But anyway, back to the never-ending day. I ended up landing in Honolulu around 9am, still on Wed. Feb. 11—in other words, I landed before I left PNG, which made me laugh. I had to calculate time zones to determine if I should take my anti-malarials or not (I did, including my first dose of my terminal prophylaxis on primaquine), and then wasted time on the internet in the Honolulu airport (I would have rather been at the beach, but we don't always get what we want) until it was time to board for the last leg of today's flying, a five-hour flight from Honolulu to Los Angeles, where I will be for a few days for the American College of Preventive Medicine conference. I'm still on that flight as I'm writing this, to be posted later.

Overall, it's an exhausting 30 hours of travel time (not counting my flights from Kikori to POM “yesterday”)—all of which spans 11 hours on the clock (10am in PNG to 9pm in LA). I'm just hoping that my sleep won't be so disrupted that I'll miss out on important parts of the conference.