Student perseverance and community and industry partnerships were highlighted in special presentations at the East Carolina University Board of Trustees’ February meeting.
The board also welcomed Brandon Frye, vice chancellor for student affairs, who officially joined ECU this week.
On Thursday, four students spoke during the University Affairs Committee meeting about their struggles and how ECU programs helped them continue to move forward. The students and the programs are: George Cherry Jr., Students’ Treasure Chest; Nellyana Cordero-Cisnero, Pirate Promise; Adam Harrison, Pirate Academic Success Center; and Iyaira Williams, Purple Pantry. Chris Stansbury, associate vice chancellor and senior operating officer for student affairs, moderated the panel.
In introducing the students, Provost Robin Coger said earning a degree requires students to persevere even when faced with challenges. ECU provides a range of support for student success. “Ultimately they come out of ECU ready for successful careers, but there are a lot of steps in between,” she said.
Cherry, who is earning three degrees and plans to attend medical school, put 24,000 miles on his car driving to class last year from his Bertie County home, where he helps take care of his younger sister. He was able to get help from the Students’ Treasure Chest when his car needed repairs. He is working to give back to the university through service and his involvement in different organizations, including the Student Government Association.
Cordero-Cisnero is a first-generation student from Raleigh who attended community college before transferring to ECU for a degree in elementary education. She said an ECU alum introduced her to Pirate Promise, which gave her a path to a four-year degree. “It opened a new door for me,” she said.
Harrison said he commuted from his home in Williamston his first year, and the connections he made at the Pirate Academic Success Center helped him become a stronger student. He now is a mentor to other students at the center.
Williams, from Raleigh, has volunteered at the Purple Pantry since her freshman year. As an ambassador, she helped the organization win a collegiate hunger challenge and $10,000, and she continues to work with the pantry to combat food insecurity. A recent partnership with the SGA has yielded almost 90 meals donated from unused meal swipes. The SGA also provided funding to purchase a freezer for the pantry to provide frozen meals.
The panel encouraged trustees to continue hearing from students and provide opportunities for conversation. They also suggested continuing to bring awareness to the resources that ECU offers.
In another committee Thursday, the trustee’s Committee on Strategy and Innovation heard an industry workforce panel discuss how partnerships can lead to innovation and economic prosperity in eastern North Carolina and beyond. Participants included representatives from ECU Health, Fly Exclusive and MrBeast. Topics ranged from the importance of building and strengthening partnerships and pathways to identifying ECU student and graduate talent to recruit to their businesses.
Panelist Julie Oehlert, chief experience and brand officer at ECU Health, said both the university and the health system can benefit from working more closely to integrate student experiences into education in a wide variety of disciplines in health care and beyond.
“We share a community, we share learners that we both love deeply, in a variety of settings,” she said. “We share the responsibility of caring for eastern North Carolina; for educating eastern North Carolina and for advancing all the people that live in eastern North Carolina in their learning and in their health. That’s why we are ECU Health now; never before has the imperative for a strong partnership been more relevant or more necessary.”
The panelists and committee discussed ways to encourage partnerships based on innovation and thinking outside the box that will push students to create real-world solutions in situations that prepare them to enter the workforce with concrete foundational experience.
The committee also adopted a resolution on freedom of expression for faculty and students, which was unanimously approved by the full board on Friday. The resolution reaffirms the Board of Trustees’ commitment to academic freedom and freedom of expression in which faculty and students can “teach, learn, seek and speak the truth” in an environment where “academic freedom flourishes” and the campus community is given “the broadest possible latitude to speak, write, listen, challenge and learn except insofar as limitations to that freedom are necessary to the function of the university.”
Trustees also received an update on refreshing the university’s strategic plan. Committee co-chair Sharon Paynter presented a list of internal and external strengths, weaknesses, threats and opportunities that impact university initiatives and ways ECU leadership, faculty, staff and students continue to navigate them.
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East Carolina University’s postgraduate program in cardiac psychology creates professionals who are ready to help patients cope as they adapt to life-saving heart devices.
On the heels of marking its 15th year, ECU’s nationally unique program in clinical health psychology continues to gain momentum through positive patient outcomes — and national recognition.
The program is a collaboration between ECU’s departments of psychology and cardiovascular sciences that has yielded a nationally unique blend of academics and research. The model integrates training psychology doctoral students and cardiology fellows in cardiac clinics, a strategy that the program’s founder calls the best of both worlds.
“This is a success story from eastern North Carolina,” said Samuel Sears, program director and professor in the departments of psychology and cardiovascular sciences. “From a national landscape, this is an extremely unique program. Only at East Carolina do you have this kind of synergized, integrated, one-for-one engagement in the training of cardiologists and the training of psychologists. Our program is intending to lead the country in this.”
Sears established the training program in 2007 and collaborates with Rajasekhar Nekkanti, associate professor and director of the cardiology fellowship program at ECU and ECU Health, to offer ECU students an integrated program experience that spans clinical care, research and training.
“Dr. Sears and his colleagues have been able to accomplish what others have only talked about,” said Alan Christensen, professor and chair of the ECU Department of Psychology. “Their seamless integration of clinical psychology into a cardiovascular medicine setting is really a pioneering effort in implementing what I believe will prove to be a more effective approach to training, research, and caring for patients.”
The growing field of cardiac psychology focuses on providing psychological care that is an interdisciplinary, comprehensive care approach to cardiac arrhythmia patients and their families.
Depression and anxiety are common occurrences after cardiac events and can occur in as many as one-third of all patients. These conditions interfere with all aspects of recovery from daily rehabilitative planning, medication adherence, and the pursuit of quality of life.
“Cardiac psychologists help by validating the emotional experience of having a heart problem, and helping patients take the next steps in their recovery emotionally and behaviorally,” Sears said. “ECU Cardiology and Cardiovascular Surgery continue to innovate, and that allows our patients to survive. Here at East Carolina, we have the vision and program to address the patient experience and recovery process fully from a psychological and behavioral perspective. We integrate all the aspects of recovery and prepare trainees for the future of cardiac care.”
The program was highlighted in a 2022 edition of Health Psychology, a journal of the American Psychological Association. The article, “Cardiac Psychology Training in a Rural Health Care Setting: East Carolina Heart Institute,” was led by author Kayla Sall, a 2023 graduate of ECU’s clinical health psychology program. Doctoral students Ashley Griffith, Emily Midgette, Andrea Winters and Connor Tripp also co-authored the article with Sears and Nekkanti.
“We are very proud to publish in our field’s top journal,” said Sall, who begins a psychology internship at Brown University this fall. “The publication goes to show how unique our training experience is. It’s very rare to find cardiac psychologists that are located in cardiology.”
The Health Psychology article covers not only the program’s unique nature of intertwining science with practice, but also its ability to adapt to the COVID-19 pandemic by transitioning to using telehealth to serve patients in rural North Carolina. It also explores the health disparities in eastern North Carolina that impact cardiac patient care and progress.
“Cardiovascular health is one of the leading causes of death in the U.S.,” Sall said, “so being able to take that lens and apply it to the social determinants of health has been amazing, and it’s how we’ve been able to do what we do.”
Greenville native and ECU graduate Scarlett Anthony didn’t have to go far to find a program that offers world-class education and preparation that will help her make a difference in her home region and beyond.
“I chose ECU’s program because of the focus on health psychology and the intersection between psychology and medicine. We train alongside psychologists who are embedded in medicine, and our program provides us with exceptional training among various health care settings,” said Anthony, a doctoral student in clinical health psychology. “I chose ECU’s program because of the dedication to serving diverse populations of eastern North Carolina, and I am passionate about providing care to those who may not have access to health psychology services otherwise.”
Standards of practice
Sall led the writing team in detailing the ECU training program and its strong collaborations in cardiology. The article presents ECU’s program as a national model for ideal collaboration between cardiology and psychology training that enhances the clinical and research expertise of both groups.
The ECU cardiac psychology program is part of the APA accredited clinical health psychology program. This program has achieved national rankings over its 15-year existence and annually has an approximately 5% acceptance. Rob Carels serves as the director of clinical training for the clinical health program.
“The article confirmed that the ECU program is not only one of a kind, but it remains the model as programs and universities try to create this similar-type experience,” Sears said. “The reason it’s so hard to create the ECU experience is that it requires both physicians and psychologists accommodating very different mindsets and contributions with the shared goal of patient success first. Physicians can quickly implant a cardiac device. Psychologists can quickly assess and treat psychological concerns. But when these two sets of problems merge, we need shared expertise.”
The article also highlights the setting of ECU’s health psychology program, a rural area where the social determinants of health — including environment, economic stability, community context, education and health access — impact health and wellness on a greater scale.
“Being in eastern North Carolina, we have a very unique setting with our patient population in a rural area,” Sall said.
That context allows psychologists to better understand the behavioral and mental health of cardiac patients. Many patients seen by cardiac psychologists at the East Carolina Heart Institute include those who suffer depression after a heart attack or other cardiac event, those with atrial fibrillation (a-fib) and those who have recently been fitted with implantable cardioverter defibrillators (ICD) — devices similar to pacemakers that correct heart arrhythmias with a high energy shock that can feel like being kicked by a horse.
“I think that is what is so scary for patients; they agree to have this device implanted, they know it’s life-saving, but you don’t know when the shock is going to go off,” Sall said. “You may go the whole rest of your life without receiving a shock, so that’s where part of the anxiety and fearfulness comes in.”
In the program’s scientist-practitioner approach, providers on each side have a thorough understanding of the opposite discipline.
“I think that’s what’s cool about cardiac psychology — here we are with people presenting with medical conditions or health issues and we’re evaluating, diagnosing, treating emotional behavioral disorders within the context of health and medicine,” Sall said. “We’re not doing just one or the other, we’re doing these together.”
World expert in action
Sears is a highly productive researcher examining quality of life and psychological adjustment in patients with heart rhythm disorders and ICDs. He has published more than 200 articles in the medicine and psychology research literatures and has well over 11,000 citations. In 2021, Expertscape.com named Sears one of the top 50 experts and most prolific authors in the world on ICDs over the last 10 years, amongst the 27,847 authors on the topic.
“I’m involved in both the training of psychologists as well as the training of cardiologists, so we’re trying to make cardiologists better at patient psychology and psychologists better at understanding the cardiology, so it’s synergistic,” Sears said.
Sears travels the world presenting his research and lending his expertise to patient, family and physician groups.
In 2013, the UNC Board of Governors presented Sears with the O. Max Gardner Award, the highest honor bestowed to a faculty member in the UNC system for contributions to mankind.
“The O. Max Gardner Award changed me because I stopped looking for external validation about our achievements. I desperately wanted to make an impact on our patients, our students, our university, our state and beyond,” he said. “The award confirmed some of these marks, so I used my energies more efficiently on the work at hand. I am proud of the health psychology program and the cardiac psychology program that my colleagues and students have created. In terms of work, I am so pleased that many of our ideas about helping cardiac patients are broadly employed across many sectors in cardiology, not just where we started.”
The article in Health Psychology signals consistent success and upward momentum for the program, said Sears, adding that Yale University’s health psychology program is the only other such program mentioned in that edition of the journal.
“This is a 15-year-old program. We’ve established success,” he said. “This is not a great idea that’s going away. Great ideas happen all the time, but they’re not sustainable. This is a sustainable solution that has true outcomes.”
When it comes to patient outcomes, Sears is optimistic that the growing field of cardiac psychology will continue to yield hope and healing.
“We can’t fix all the health inequalities, but what we can do is help our patients make small steps to have better awareness of where there are a lot of possibilities and decision points, and connect them to other resources,” Sears said. “Yes, this is a hard mountain to climb. Let’s do this together.”
Doctoral student Zachary Force said students begin the program learning what clinical health psychology can offer the world — and how ECU is leading the way.
“ECU has always done things differently, and other institutions are starting to take notice. ECU’s cardiac psychology service has received national recognition as the only place in the country to receive specialized training in an area with increasing need,” he said. “ECU’s fighting spirit imbues its doctoral students with the resiliency needed to advocate for psychology within the medical field.”
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Halifax, N.C. – ECU Health proudly joined community officials and business and health leaders at a Medicaid expansion roundtable hosted by U.S. Congressman Don Davis at the Halifax County Health Department Friday, Jan. 20, 2023, followed by a tour of ECU Health North Hospital.
Jay Briley, president of ECU Health community hospitals, and Jason Harrell, president of ECU Health North Hospital, attended the roundtable to offer insights on health issues impacting Halifax County and eastern North Carolina. Officials urged the need for Medicaid expansion, and community leaders offered perspective and insight on how to best advocate for expansion in North Carolina, which would provide invaluable health and economic benefits to communities across the region. With Medicaid expansion, more than 600,000 North Carolinians – 100,000 of whom live in eastern North Carolina – would have access to the affordable health care coverage they need.
“ECU Health is grateful for the opportunity to meet with Congressman Davis and other community leaders to discuss Medicaid expansion and other important health care needs for Halifax County and the region we so proudly serve,” said Briley. “Medicaid expansion is a crucial initiative that would provide numerous benefits for the state, and especially here in rural eastern North Carolina, where we see high rates of chronic diseases and high rates of uninsured patients. Simply put, Medicaid expansion would make an important difference in the lives of so many, and we are committed to advocating for this important measure.”
Following the roundtable, Briley and Harrell welcomed Congressman Davis to ECU Health North Hospital for a tour of the hospital, including the oncology unit and women and children’s unit. During the tour, the leaders discussed how Medicaid expansion and the Healthcare Access and Stabilization Program would help provide much-needed relief for rural hospitals across the state, ensuring that rural North Carolinians have access to high-quality health care.
“Rural hospitals like ECU Health North play a critical role in the communities they serve,” said Harrell. “Our hospital is not only a hub for high-quality care, but it is also the largest employer in the county. Medicaid expansion should be a top priority for the state, and we appreciate Congressman Davis’s efforts to advocate for the health and well-being of eastern North Carolina.”
“It was very nerve wracking coming here,” said Denique Barnett, a pediatric rehab nurse at the James and Connie Maynard Children’s Hospital and international nurse at ECU Health. “I’m an only child, so leaving my family in Jamaica was very hard.”
For Barnett, pursuing her passion has been a journey of more than a 1,000 miles.
“The welcome that I received was a good one,” Barnett said.
The warm reception Denique received is one ECU Health offers nurses from around the world as part of the International Nurses Program.
“My passion is pediatrics, but specifically neonatal nursing,” Barnett said. “Back home there is no degree program for neonatology. So I decided that, you know, to further my studies and to self-actualize, I would need to come to the United States.”
Not only does the program foster additional growth and training for participants, it also fills an important recruiting need for the health system.
“We bring international nurses from all over the globe to come to our organization to spend about two years in a clinical environment,” said Charlene Wilson, chief people officer of ECU Health.
Launched in November 2019, 175 nurses from 21 countries have since spent time at ECU Health.
“Even though these are nurses that are seasoned nurses, they have to go through our NCLEX,” Wilson said. “They then go through the immigration process. They then begin to understand the culture of the various hospitals that have openings for international nurses. One of the things that is very different about their practice here versus their practice in their home countries is the technology.”
“At first, you know, getting used to just how things are done here using technology for me, that was a bit of a challenge,” Barnett said.
“I’m always told by the clinicians, including the doctors, that one of the things that is fascinating about what they bring is their analytical skills, because they don’t have the technology that we have here in the United States,” Wilson said.
It’s a unique perspective put to work for a common goal, improving the health and well-being of the region these nurses now call home.
“As an international nurse, making the leap is the best decision that you will make. There is a lot of opportunities for growth,” Barnett said. “There are a lot of benefits to being here at ECU Health, you know, just make the leap, come, you won’t be disappointed.”
Greenville, N.C. – ECU Health, the premier health system serving eastern North Carolina, experienced a transformational year highlighted by the introduction of a new brand, announcement of a new behavioral health hospital, recognition of multiple team members on the state and national levels and realization of clinical achievements and innovations that enhance the care for the 1.4 million people the organization proudly serves.
“As we reflect on the historic year that was and celebrate our achievements, I want to take a moment to extend my heartfelt gratitude to the team members who make ECU Health what it is: a premier rural academic health system dedicated to serving the people who call eastern North Carolina home,” said Dr. Michael Waldrum, ECU Health CEO and Dean of the Brody School of Medicine. “As one year comes to a close and another begins, I know the next chapter of our shared story will be just as important. Our efforts in 2022 helped position us to navigate the complex challenges we face moving forward by bringing clinical, education and research innovations, but we still have work to do in the upcoming year and beyond to ensure our communities have access to the high-quality care they deserve.”
The following highlights are only a few of the many achievements across ECU Health in 2022. For a more comprehensive review of the year, please visit: ECUHealth.org/YearinReview2022
Evolving to ECU Health
The re-brand to ECU Health is a visual reminder of how transformative the year has been. The ECU Health logo is a symbol of the commitment to transforming and elevating health care for millions, training the providers of tomorrow, collaborating with community partners to solve complex issues and bringing clinical innovations that improve the lives of those who call this region home.
The Brody School of Medicine at East Carolina University and the health system began a joint operating agreement on Jan. 1, 2022. In April, the two organizations hosted a press conference and shared the new logo for ECU Health and announced the brand launch that would begin in May.
In the months since, there have been visual changes across the health system from signage around hospitals and clinics to websites and social media channels. More importantly, the creation of ECU Health has opened the door for the system to improve access to care across eastern North Carolina while training health care professionals through Brody.
Expanding access to behavioral health care in eastern North Carolina
Access to behavioral health care is crucial across the country, but especially in rural areas like eastern North Carolina. In June, ECU Health and Acadia Healthcare announced plans to build a state-of-the-art, 144-bed behavioral health hospital in the medical district of Greenville, less than a mile from ECU Health Medical Center.
Slated to open in spring 2025, the hospital will operate through a joint venture between ECU Health and Acadia, the largest standalone provider of behavioral health care services across the United States. Together, the organizations will invest approximately $65 million in expanding behavioral health resources in eastern North Carolina.
The hospital will include 24 inpatient beds specifically for children and adolescents with mental health needs. These beds will be the first of their kind in ECU Health’s 29-county service area and the only child and adolescent beds within 75 miles of Greenville, North Carolina.
Twenty-two ECU Health nurses recognized among Great 100 Nurses of North Carolina
This year, 22 ECU Health nurses were selected to the 2022 NC Great 100. This is the largest number of ECU Health nurses to receive this recognition. The honorees were celebrated at a gala hosted by The North Carolina Great 100, Inc. in Greenville in October.
Since 1989, The North Carolina Great 100, Inc. has recognized and honored nurses around the state for their commitment to excellence and to promote a positive image of the nursing profession. Out of thousands of nominations that are submitted annually, 100 recipients are selected based on their outstanding professional abilities and contributions made to improving health care services to their communities.
ECU Health Beaufort Hospital designated as primary stroke center by The Joint Commission
In July, ECU Health Beaufort Hospital – a campus of ECU Health Medical Center was designated as a primary stroke center by The Joint Commission and the American Heart/Stroke Association, recognizing the hospital’s preparedness and expertise to care for stroke patients. Stroke is one of the leading causes of death in the state, resulting in more serious long-term disabilities than any other disease.
With ECU Health Beaufort’s designation, all ECU Health’s hospitals are stroke certified by The Joint Commission.
The holiday season brings so much joy, especially for young children and their families that get to see them light up as they unwrap presents.
While picking out toys that young ones will love, it is also important to consider the safety of the toy, Ellen Walston, Injury Prevention Program coordinator at ECU Health Medical Center, said.
In 2021, there were more than 152,000 toy-related, emergency department-treated injuries to children under the age of 15, according to the Consumer Product Safety Commission.
“I think the thing is, because of COVID and supply chain issues, a lot of parents have a lot of pressure on that perfect gift,” Walston said. “But you don’t need to sacrifice safety.”
Walston noted toys with many pieces and stuffed animals with poorly sewn features as choking hazards for small children. A good test, she said, would be to use a toilet tissue roll to see what kinds of items might be a choking hazard for a child. If it could get stuck in a toilet tissue roll, it could be ingested and become a choking hazard.
She said often older children and younger children in the same home can play with different toys that may be safer for the older child than the younger child. It is important to remind older children to put away toys when they are done using them to make sure younger children cannot get hurt using that toy or ingesting pieces.
A key concern each year, though, is button batteries, Walston said. Button batteries can be found in many objects around a home, including car key fobs, thermometers, scales and some remotes. These can also be found in books that play music and many singing cards. Walston said if a child gets to these batteries, it can be very dangerous — not only as a choking hazard, but also the possibility for chemical burns from the battery.
Last, Walston reminded anyone purchasing a bike for a child to not forget a helmet and bell or another item that makes noise.
Walston said it all comes down to making educated choices and supervising young children while they play to keep them safe and avoiding an emergency.
“Please make sure that you’re paying attention to labels,” Walston said. “If a toy says ‘not recommended for a child under three years of age,’ you have to take those warnings seriously. Also, supervision is critical and just making sure that children are safe when they’re playing.”
Keeping children safe with their toys helps ensure a happy holiday season for all.
Resources
ECU Health Beaufort Hospital, a campus of ECU Health Medical Center, hosted free community health screenings, produce giveaways and educational information at its first fall harvest event at the new community garden and outdoor classroom on Nov. 18.
The community garden and outdoor classroom, located next to the ECU Health Wellness Center in Washington was made possible — in part — by a grant from the Robert Wood Johnson Foundation and the garden was developed by the ECU Health Patient Education team in collaboration with ECU Health Beaufort Hospital. Internal partners include the ECU Health Beaufort Hospital Food & Nutrition Services team, Community Health Improvement team, Volunteer Services, the Wellness Center, and Facilities & Properties.
“It has been wonderful working with such an innovative team,” said Tammy Thompson, director of Experience Engagement, Education and Design at ECU Health. “They have been true partners throughout entire process.”
Sowing the seeds for health and well-being
Over the summer, the garden started to take shape, resulting in 10 raised beds for vegetables, two large metal planters for herbs, fencing, a shed and space for community members to come together and learn outdoors. The hospital planted the first crops in September for the first harvest event.
Pam Shadle, director of Marketing, Community Outreach and Development at ECU Health Beaufort Hospital, said the opportunity to come together as a team and create something that will benefit the community has been a great experience.
“It’s been a labor of love since the creation of the idea,” Shadle said. “So many of our team members from various departments came together to make this happen, so it’s been a great opportunity for our folks to get involved and I really appreciate that.”
Shadle said the community garden and outdoor classroom is an integral addition to their community health improvement plan for Beaufort and Hyde county residents. While they already feel the great impact of existing programs on community health, the garden will help create new opportunities and help improve those established programs, Shadle said.
Beyond the harvest
The ECU Health Food and Nutrition Services team joined the event and shared easy-to-make recipes inspired by the garden’s produce — which includes vegetables and herbs like broccoli, collards, kale, lettuce, rosemary and thyme. Along with the opportunity to take home fresh, free produce, clinical teams were on hand to offer health screenings for community members, and the Wellness Center team shared information about lifestyle medicine and other services to support community wellness.
“It’s just a great complement to include these offerings because what we’re trying to do is not solely about food,” Dr. Thompson said. “We call these living-learning labs because of the interactive engagement to support healthy lifestyles. This is an opportunity for community members to receive a variety of information and resources for better health.”
ECU Health Chief Experience Officer Julie Oehlert, DNP, RN, said the garden is an important step in the community health work in eastern North Carolina.
“We’re so proud of the teams that made this garden a reality,” Dr. Oehlert said. “It’s going to benefit community members, team members and patients in the hospital and I think it’s really special for us to connect with the communities we serve in this way. We’re excited to offer something unique for Washington and Beaufort County and I know we’re going to learn so much from this project.”
Planning your visit
The garden will be open to community members from 9 a.m. to noon each Wednesday and Friday where any produce ready to be harvested will be distributed and other educational materials will be shared.
Learning your child is sick is devastating, in any language.
“He got sick when he was two years old,” Miguel Morales’ mother, Maria Martinez, said in Spanish. “His diagnosis was spelled LCH. It is one of the somewhat aggressive cancers. It was a very, very difficult process for him. Very painful for all of us to see my son suffer every day without being able to understand why he does not speak much.”
LCH, or Langerhans cell histiocytosis, is a rare form of cancer that most commonly appears in toddlers and children.
Complicating the diagnosis — the fact that English is a second language for Miguel, his mother Maria and their family.
“We take care of our patients that have are limited English speakers,” said Tania Elguezabal Christensen, Interpreter Services manager at ECU Health. “So we help them to navigate our health care system and we help them communicate with our providers, with our doctors and nurses about their health care.”
Tania and the Language Access Services team — which is comprised of interpreters and translators — help bridge an important gap for patients and families during a hospital stay. An integral part of a patient’s care team, they offer services for 240 languages and dialects across the ECU Health system.
“When we go to get medical treatment, we all want to understand what our diagnosis is and what the treatments are,” Elguezabal Christensen said. “When people don’t speak the language, it’s hard to understand all of that. That’s why it’s so important for us to be a conduit between patients and providers.”
Martinez said she was grateful for the assistance the Language Access Services team provided while her family navigated a challenging time.
“It was a very good thing for me,” Martinez said. “They have been very supportive during this long process with my son. They have helped me to better understand his situation, how to properly give the medications, and to clarify many doubts that I had with the doctors. Since I do not speak the language, they have been a very important source of support for me.”
One part of the journey that is easy to understand in any language, the milestone moment Miguel got to ring the bell at the James and Connie Maynard Children’s Hospital at ECU Health Medical Center. It’s a celebration of beating cancer, surrounded by the many teams who helped him along the way.
“For me it meant life, it meant opportunity, it meant opportunity to have my son with me,” Martinez said. “It meant everything. It meant that some of my worries about losing him were fading away. It meant that I could see him grow.”
Today, Miguel is a happy, typical 4-year-old boy. He loves to play and jump around, which was difficult for him to do while he was sick.
Martinez is grateful for the outcome — and for those who made it possible.
“Well, I thank everything, first to God and for giving us the opportunity to heal my son, to the entire doctor’s team, from interpreters, nurses, doctors, everyone who was there, the whole team because they really helped us a lot,” Martinez said.
Along with sharing her appreciation for her healthy son, Martinez also wants other parents to learn from her family’s experience.
“More what I would like to say is just my experience as a mother,” Martinez said. “I would tell people that are out there listening to me and mothers out there — ask questions. If someone tells you this is just an infection, keep digging and keep asking questions.”
Resources
Doctors, nurses, therapists — none can do their clinical jobs without facts: proof, by way of blood tests, X-rays and hands-on observations in order to determine a clear path forward to progress a patient to wellness.
The acute skills of observation and diagnosis are critical for the individual patient, but before health care providers can make clinical judgements and chart a path forward for their patients, health care as a whole needs facts. The facts that systemic health care requires comes in the form of research, which has given us modern medical wonders like antibiotics, MRIs, gene editing and thousands of other discoveries and inventions that have made historical medical death sentences into minor inconveniences.
The tradition of research in the pursuit of making health care better, particularly for those in rural and underserved communities in eastern North Carolina, is alive and well at East Carolina University and ECU Health. Here are a few examples of how Pirate researchers are improving lives one study at a time.
Women living with HIV
Dr. Courtney Caiola, an assistant professor at ECU’s College of Nursing and researcher focusing on women and HIV, said that that the HIV epidemic has made an insidious shift, from largely affecting urban populations in the epidemic’s early days to now having taken root in rural and underserved regions — eastern North Carolina has become a ready refuge for the disease.
The National Institute of Nursing Research has funded one of Caiola’s research projects that aims to find out how best to communicate with women living with HIV in rural settings, particularly for those without reliable access to high-speed internet connectivity.
Caiola is fighting an uphill battle, one complicated with social mores and community stigma for residents of rural and underserved area who are diagnosed with HIV.
“The epidemic has changed over the years, in good ways,” Caiola said. “People living with HIV are living really well now, but women living with HIV in the South have some of the highest rates of HIV infection but the lowest rates of viral suppression, which means that that they’re not engaged in care.”
Cultural barriers and social stigma often prevent many women in the South from seeking care, Caiola said. Women in a more urban setting might be able to visit an HIV clinic with little fear of disclosing her HIV status, but that isn’t necessarily the case when community members know which clinics serve patients living with HIV.
Caiola’s research partners well with an outreach and research project spearheaded by Dr. Leigh Atherton, an associate professor in the Department of Addictions and Rehabilitation Studies at ECU’s College of Allied Health Sciences.
Atherton endeavors to find ways to prevent the spread of HIV in rural North Carolina by encouraging those in high-risk substance use groups to seek treatment for their addictions. Atherton’s team partners with community-based HIV outreach groups and supplements testing supplies, which puts his counselors in direct contact with at-risk populations.
One of the highest hurdles to clear for researchers focused of HIV treatment and prevention in North Carolina is simply getting enough people to participate in the research.
“There’s something called courtesy stigma. A lot of women with HIV are mothers and they don’t want the stigma that they might experience to be passed on to their kids, so they tend to keep very low profiles and be a bit socially isolated,” Caiola said, which necessitated her team partnering with multiple other HIV researchers in North Carolina and across the South.
Initial research findings suggest there is no one-size-fits-all solution to communicating with HIV positive women in rural areas.
“As clinicians, the differences in the way people respond to their circumstances is often very clear, but in research, people are often grouped into broad demographic groups for the sake of generalizability,” Ciaola said. “In fact, two women with similar demographic profiles, like Black women living with HIV in a rural area, may have wildly different responses to dealing with HIV.”
Disease prevention
For Brody School of Medicine Drs. Greg Kearney and Doyle ‘Skip’ Cummings, health-related research orbits around overarching conditions that spiderweb across the body creating a cascade of adverse consequences — hypertension and environmental public health.
In order to find ways to address the high levels of hypertension in rural areas, Cummings is piloting a program, in collaboration with UNC-Chapel Hill and the University of Alabama, to test home health reporting technologies that can identify high blood pressure patterns and upload those readings into a computer system for a team of health care providers to evaluate.
“Instead of just one provider seeing a patient every three months or so in the office, we’ve got a team of people that are trying to stay on top of blood pressure values and recognize when a patient’s blood pressure patterns appear to be out of control, signaling the need for quick follow up, often by telephone or telehealth,” Cummings said.
In setting patients up with the telehealth devices being tested, researchers are using the in-person meetings as an opportunity to gather baseline information that can be used to identify some of the causes of hypertension in disadvantaged and rural communities.
“We’re using screening instruments during the baseline visit to look at the social determinants of health — food insecurities and transportation and housing instability,” among other data points, Cummings said.
Cummings, a Brody professor of public health and the Berbecker Distinguished Professor of Rural Medicine, said that the amount of data that the system transmits from a patient’s home to the central computer is so small that the team has had no problems thus far with getting data to the health care team.
“I just came back from two days of site visits out in the mountains in rural North Carolina and we took the blood pressure cuff with us,” Cummings said. “We drove all over the mountainous areas and tried the blood pressure cuff in multiple places, and we didn’t have any problems. Part of it is because that blood pressure value is a very small amount of data. It’s not like you’re sending a video or pictures.”
Kearney’s research is rooted in a desire to understand environmental and occupational impacts on human health, particularly asthma and the effects of chemicals and pesticides on farm workers.
Kearney, an associate professor of public health at Brody and founding director of the school’s Environmental and Occupational Health Program, is working with a toxicology researcher at UNC-Charlotte, who has developed a portable medical device that can be used to test for pesticides in human blood.
Kearney said that they have pilot tested the device with farm workers working with different crops.
“Because of the nature of their work, they are in the fields daily during the season, and are at high risk for exposure to pesticides,” Kearney said. “Some pesticides are quickly metabolized in the body’s systems, so a person who is exposed and located in a rural area may have difficulty getting tested right away. With a simple finger stick and a drop of blood, this device can quickly alert you to pesticide exposure.”
Last year, Kearney organized a team and worked with community partners to conduct a regional community health needs assessment for the eastern part of the state. The project included working with representatives across 33 mostly rural North Carolina County health departments and ECU Health.
This research is critical for not-for-profit hospitals, which are required by law to complete community health needs assessments every three years, to understand how to plan for health care investment.
“The community health needs assessment and outcomes is a very serious process,” Kearney said. “It provides a mechanism for hospitals and communities to come together and decide how to invest funding with community-based organizations to address the most pressing health care related problems in their communities.”
Fresh start
In eastern North Carolina, people with Type 2 diabetes are twice as likely to die as the rest of the state and the country.
Fresh Start, a research and outreach project established by Dr. Lauren Sastre, associate professor of nutrition science at the College of Allied Health Sciences, partners with free clinic members of the North Carolina Association of Free and Charitable Clinics across 11 counties in eastern North Carolina. The research and outreach program aims to prove is that diabetes can be controlled by layering previously disparate approaches to diabetes management — providing healthy food to those in need, teaching patients how to incorporate food and exercise into their lives and building accountability structures.
“I’m from North Carolina, and I don’t want to keep seeing that we have diabetes in this region that is out of control,” Sastre said. “There are problems that are hard to solve and this one isn’t hard to solve — it’s just whether or not we are actually going to do it.”
Sastre and her expansive interdisciplinary team of dozens of ECU students, trainers and researchers hope that through teaching patients healthy ways to cook and how to put structures for accountability in place, the Fresh Start program could help patients learn to more effectively manage their disease.
“The question we asked ourselves was, ‘Can these things that other people have done individually, that have shown some effect, complement each other and should the synergy be more impactful?’” Sastre said. “It turned out to be what we hoped it would be.”
The first challenge, exposed early in the research process, was to get to diabetes patients where they were. Sastre’s team found, through face-to-face engagement with patients, that many in rural communities have a very real lack of digital connectivity.
“Everything is done over the phone with health coaching, and we’ve even moved in-person classes to the evenings,” Sastre said. “A lot of our folks are considered the working poor and they make just enough to not have a lot of help and they can’t go to classes in the morning or afternoon.”
Sarah Elliott, a junior studying nutrition science and a Fresh Start volunteer, was heartened by the progress that her patients made.
“We have received really positive patient feedback from the group classes and the health coach experience. People are saying, ‘Not even my own family care as much about my health as my health coach did,’” Elliott said. “It has been impactful to see the difference that this is making in people’s lives.”
And what does the initial research of this integrated approach to diabetes management show?
A1C, one of the blood markers of the body’s control of blood sugar, will typically go down one to one and a half percent with Metformin, which is the standard medication that diabetics are put on initially. The Fresh Start program’s mean decline in just four months was 1.87 percent, which is significant accomplishment that Sastre credits to the program’s multi-layered approach to food and lifestyle management.
“The patients enrolled in our program, their blood sugar control improved for some almost double what it could with some medications,” Sastre said. “Our patients also had reduced hospital re-admission rates, so we know that the program is working. It’s addressing diabetes and improving quality of life. It’s making an impact on disparity.”
Brandon Stroud, a doctoral student, knows farming in eastern North Carolina. He grew up on a farm near Dunn and his grandfather worked several hundred acres of land close to where Stroud was raised.
Undergraduate students, Stroud said, are taught in classrooms the skills they will need to be effective in a hospital setting. Research skills students learn working with patients in the Fresh Start program helps them to evaluate the effectiveness of integrating the three pillars of the program, which makes book learning real.
“This is different than lab-based research,” Stroud said. “It’s community-engaged research, right? So, you’re working with many different partners out in the community — clinics, farmers and different organizations. It teaches us the life skills that we need to be beneficial moving forward whether we want to go into business or continue down a clinical route. The research validates our personal experiences when we are able to employ rigorous evaluation and report these meaningful outcomes.”
Mount Airy, North Carolina, sits three miles south of the Virginia state line, a community of 10,000 so prototypical of Southern charm that it’s accepted as the basis for the town of Mayberry from “The Andy Griffith Show.”
Surry County — where Mount Airy is located — is considered a dental health professional shortage area, along with the rest of North Carolina, according to the Health Resources and Services Administration.
When Dr. Laura Mercer, a native of Mount Airy, graduated from East Carolina University’s School of Dental Medicine in 2019, she headed back to her hometown to practice — a native daughter returning to care for the community that raised her.
“It’s such a humbling experience to be able to serve the community that helped shape me into who I am today,” said Mercer, a dentist at James H. Wells, DDS. “I love being able to connect instantly with my patients when I tell them I am from Mount Airy. It’s a great first step to building lifelong relationships with my patients.”
Mercer is a prime example of the dental school’s mission to develop leaders with a passion to care for the underserved and improve the health of North Carolina and the nation. In the past four years, the School of Dental Medicine has won two national awards for its innovative model of education and patient care — one for placing eight community service learning centers (CSLCs) in communities across the state, and the other for its commitment to advancing social mission and exploring ways to better serve rural parts of the state.
The school’s earliest vision — when the idea of a dental school in Greenville was still picking up steam in the 2000s — included a promise to educate new dentists who were naturally inclined to remain in North Carolina and practice in rural and underserved parts of the state. The school’s system of CSLCs was a built-in part of that mission that soon became tangible. More than a decade later, the model has yielded solid results and credibility to the school’s commitment to immerse students in the challenges and rewards of practicing in rural locations.
Those relationships are built from the ground up before students leave the ECU School of Dental Medicine.
Fourth-year dental students spend nine weeks in three different CSLCs across the state, for 27 weeks of experience living and working in communities whose residents face a plethora of disparities, from financial hardships to geographical access— in addition to other obstacles in the way of care for many socially disadvantaged patients.
The CSLCs, campus and hospital clinics and other locations have enabled the school’s faculty, students and residents to care for more than 92,000 patients from all 100 of the state’s counties. Close to 90 percent of the school’s more than 400 alumni are practicing in North Carolina.
“We envisioned, very early on, a model of education and patient care that would not only address the oral health care gap in North Carolina but also instill in future dentists a desire to put their talents to work in rural and remote communities,” said Dr. Greg Chadwick, dean of the ECU School of Dental Medicine. “We will continue to create pathways to oral health care in rural communities as we encourage our graduates to practice within reach of all North Carolina patients who need them.”
From the Appalachians to the Atlantic
As part of her dental school experience, fourth-year dental student Kari Wordsworth has lived and worked in the communities of Spruce Pine in the mountains and Brunswick County in the southeast corner of the state. Two of the school’s CSLCs are in those areas — the others are in Ahoskie, Davidson County, Elizabeth City, Lillington, Robeson County and Sylva.
“It’s empowering to physically be living out our dental school mission,” Wordsworth said. “Getting to be a part of what our school is doing — providing a sustainable model to provide care to these rural areas where otherwise they may not have access to care near them has been so rewarding.”
Caring for patients on opposite ends of the state has shown Wordsworth that while dental patients can face many of the same challenges and socioeconomic barriers to care, their rural communities are different in many ways — presenting additional considerations when exploring the best route of care.
“I have better understood that different patient populations have different needs, and they can become pretty unique,” she said. “Here in Spruce Pine, we see a lot of kids, whereas in my time in Brunswick (County), I saw a lot of folks who have retired. Ahoskie had a lot of special needs patients.”
That exposure to different populations can contribute to graduates’ decisions to practice where they are needed most.
“In North Carolina, where all 100 counties are health professional shortage areas, no matter where students go there are going to be underserved populations that they need to know about and understand how to best get them in for care,” said Dr. T. Rob Tempel, the dental school’s associate dean for extramural clinical practices. “What’s unique about ECU’s model is our students live for 27 weeks out in these rural communities, and the teammates they work with live in these rural areas. The students get to build relationships with them and see what’s important to them and their families and friends in the rural areas.”
In addition to the CSLC communities, students, faculty, staff and residents are spending time in counties with few or no practicing dentists. The Bertie County School Based Oral Prevention Program, a program based on a grant from the Duke Endowment, works to provide long-term oral health care and build positive dental hygiene habits in school children in that community. A similar program is slated to kick off in Jones County early next year.
Earlier this year, the School of Dental Medicine opened a small clinic in Hyde County to offset the lack of access for people from the region and to strengthen the ties between oral health and primary care.
“What really makes us unique is we include the communities in the conversation in order to build sustainable solutions for us to keep the promise that we have with the state for our dental school, by getting feedback from the stakeholders, including them in developing solutions and everybody’s challenges and opportunities are understood,” Tempel said. “Hyde County is a perfect example of that; we involved that community and we’re continuing to make a difference.”
Tempel added that trust is a key factor in reaching rural and underserved communities.
“It’s also really important to understand the value of trust and what you need to do to establish that with the people in these communities to be successful in meeting their needs,” he said. “We have to be part of the primary care system — and in rural areas, that’s amplified. Everyone has to work together to be successful in getting through these barriers to care.”
Reaching out and leaning in
Three years into her career, Mercer feels secure in her academic and clinical foundation built at ECU.
“The School of Dental Medicine helped me succeed as a dentist in a rural area of the state by making me a well-rounded professional,” she said. “The program did a great job of making sure I became competent in all areas of dentistry so that I could provide most services to patients without having to send them miles away.”
After earning a degree in molecular biology in 2016 from ECU, Dr. Darian Askew graduated from the dental school in 2022 and practices in Roanoke Rapids. Originally from Hertford County, Askew completed a rotation at the CSLC-Ahoskie. He credits the dental school with teaching him how to interact with people from different backgrounds, cultures and places.
“I don’t believe I would be exposed to the same level of cultural variation at a school localized to one area,” he said before graduation. “Being able to relate, empathize and interact with people on almost any level, I believe is a great trait to have, and probably my greatest strength now.”
More of that exposure also comes from programs that support rural patients who may be in search of a dental home — an office they can establish with and return to for routine care. Since 2018, the school’s ECU Smiles for Veterans events have provided care for nearly 250 veterans. The Sonríe Clinic, held at Ross Hall, provides care for migrant farmworkers from eastern North Carolina. Many students and faculty participate in North Carolina Dental Society Foundation Missions of Mercy clinics across the state that offer free or low-cost care. Others travel as part of “mobile clinics” that provide care during events across the East.
New and existing partnerships with local and state organizations and institutions also help the school reach rural and underserved areas.
“ECU values the partnerships with the dental societies, other educational institutions, oral health collaboratives, community colleges and the many private funders that see the value of health care,” Tempel said. “We certainly serve as a model for how this can be done effectively and collaboratively. Our relationship with community colleges is absolutely an example to others on how we can develop the work force and get them back in rural areas.”
Chadwick said much of the success of the dental school during its first decade comes from relationship-building, solution-seeking and action-taking.
“Addressing better access to health care for rural and underserved communities is not something we can do alone. It takes partnerships and collaborations with stakeholders across the state, and the School of Dental Medicine has been building those relationships since its planning phases,” Chadwick said. “By working together, thinking creatively and acting purposefully, we are meeting our patients where they are — and we’ve been able to do that because we have become a part of their communities and their lives.”