Duke - Patrick Adams https://alumni.duke.edu/magazine/author/patrick-adams en Healing and Helping https://alumni.duke.edu/magazine/articles/healing-and-helping <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td> </td></tr><tr><td valign="top"><div class="media-header top2 "><div class="media-h-credit">I left for Haiti five days after the earthquake. I flew into Santo Domingo, hitched a ride to a small port town six hours south, and managed to make it aboard a Dominican Navy ship, the <span class="pubtitle">Tortuguero</span>, ferrying food, water, and medical supplies to Jacmel, a city of 40,000 on the country’s picturesque southern coast.</div></div><p>Up till then, news accounts, and the bulk of relief efforts, had focused almost entirely on the devastated capital, Port-au-Prince, approximately fifty-five miles to the north. Jacmel, like much of the rest of the affected area, had been largely ignored. Fifty percent of the buildings were damaged or destroyed. An estimated 3,000 people were buried under the rubble. And those hospitals still standing had exhausted their reserves of medicines and supplies.</p><p>As a freelance journalist, I travel often. But I had never been to Haiti. I wanted to find out what was going on, and I wanted to wade in from the shallow end. Jacmel, long the country’s top tourist destination, renowned for its friendly people and low crime, seemed like the best place to start. I packed a week’s worth of food, a stock of antibiotics, some clothes, some cash, and a tent and hoped for the best.</p><p>The first people I met in Jacmel were Nick and Gwenn Mangine, a young, hip missionary couple from Clayton, North Carolina. And I was lucky I did; I had planned to make camp that first night on the beach by the port. But the Mangines insisted I pitch my tent in their front yard, alongside them and the nine Haitian kids they were caring for, all of whom were sleeping outside for fear of the aftershocks.</p><p>The Mangines had come to Haiti nine months earlier with their three biological children to run the Haitian Children’s Home, a refuge for orphaned and abandoned children on the outskirts of town. After the quake, though, they’d been thrust into the role of relief worker: The United Nations’ World Food Program wanted their help with distributing MREs, and the Red Cross needed their warehouses to store medical supplies. But it was the day the mayor put them in charge of Jacmel Airport that the Mangines understood how large a role they were to play. “We’ve become airport administrators,” Gwenn told me the day I arrived. “We’re directing planes where they need to go, handling the flight manifests, checking passports. Because, basically, there are flights coming in, and there is no one else to do this.”</p><p>For the first three weeks, I helped the Mangines and a half-dozen other volunteers run civilian-aid operations out of the airport, which had also become headquarters for Operation Hestia, the Canadian Forces’ humanitarian relief effort. All day, as Sea Hawk helicopters and Hercules transport planes thundered overhead, we conducted needs assessments at the clinics around town, found tents and tarps for incoming medical teams, and reported on the U.N. cluster meetings, where, in time, representatives of all the major agencies met to coordinate their activities and identify gaps.</p><p>On one of my first days in Jacmel, I helped a Dominican Red Cross team set up in Pinchinat, the city’s soccer-stadium-turned-refugee camp, where an estimated 5,000 displaced persons had congregated after the quake, many of them refugees from Port-au-Prince. U.N. peacekeepers patrolled the sea of makeshift huts—assembled with sticks and bed sheets and scraps of tin fished from the rubble—while aid workers with Save the Children built the wooden frames for the camp’s first latrines.</p><div class="media-header top2 "><div class="caption caption-center"><div class="caption-width-container" style="width: 670px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-4345197096326b0279afo.jpg" alt="Life goes on: Girls jump rope in Jacmel’s soccer stadium, where some 5,000 displaced people congregated after the earthquake." width="670" height="240" border="0" /><p class="caption-text"><div class="media-h-caption">Life goes on: Girls jump rope in Jacmel’s soccer stadium, where some 5,000 displaced people congregated after the earthquake.</p></div></div></div></div></div><p>Yet there were no doctors in sight, and as the Red Cross team made its way through the camp, a crowd started to gather. There was an elderly woman holding an infant that was too weak to cry and a small boy, naked from the waist down, with his head wrapped in blood-stained gauze. There were children with hair bleached by kwashiorkor (a disease caused by malnutrition) and others with festering wounds that wouldn’t heal. And everywhere, I was told, the invisible trauma of mental distress. Never before had I so wished I had the power to heal.</p><p>But I didn’t, and instead I fetched chairs and tables from a nearby school and helped the doctors and nurses set up a tarp to work under as patients lined up for the chance to be seen. Mothers, traumatized by the earthquake, explained that they couldn’t breastfeed their malnourished babies. And children suffering from gastrointestinal infections, one of the leading causes of illness owing to the lack of clean water, complained of cramping stomachs and diarrhea. Scabies and other skin infections were common in the camp, and cases of malaria and dengue fever were already on the rise, far ahead of the rainy season.</p><p>Still, life went on. Women prepared meals over charcoal fires, while children chased one another through the corridors of tents or played games in the open spaces. Boys flew kites and kicked soccer balls, and girls jumped rope, singing and cheering as each waited her turn. And just as the stakes were pounded into the ground and the tarp went up over the tables, the rain came down, pouring on the people in line, who stood there in spite of it.</p><p>While volunteers assisted Haitian health-care workers in Jacmel, Partners In Health (PIH), a Boston-based nonprofit organization, had taken a lead role in relief efforts in Cange, a small town about 100 miles to the northeast. Cofounded in 1987 by Paul Farmer ’82, a Duke trustee and U.N. Deputy Special Envoy to Haiti, PIH serves the country’s poorest and most-marginalized populations. In the process, PIH, which is staffed almost entirely by Haitians, has strengthened local capacity and vastly improved the control of chronic infectious diseases, serving as a model of care for organizations in resource-limited settings around the world.</p><p>Indeed, as Tracy Kidder, Farmer’s close friend and biographer, observed in a recent editorial in <span class="pubtitle">The New England Journal of Medicine</span>, Zanmi Lasante, the Haitian branch of Partners In Health, had been the largest health-care provider in rural Haiti before the earthquake, with close to 4,000 Haitian employees—approximately 90 percent of its staff—operating out of twelve medical facilities across the province. “After the quake,” Kidder wrote, “[ZL] became (temporarily, at least) the largest and one of the most important in the entire country.”</p><p>“We are in uncharted territory,” Farmer told an overflowing audience at Harvard Medical School in early February, describing Haiti’s devastation as an “acute-on-chronic” affliction—evident, at last, to the entire world. In an effort to support Partners In Health as it navigated the unknown, Duke University Health System (DUHS) dispatched a fourteen-member team of health-care professionals, the first of three to date, to provide emergency surgical services and care for people with chronic infectious diseases, such as HIV/AIDS and tuberculosis.</p><div class="media-header top2 "><div class="caption caption-center"><div class="caption-width-container" style="width: 670px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-45348091294b830ffca2o.jpg" alt="Triage and treatment: At a rural hospital on the outskirts of Jacmel, volunteers saw a steady stream of patients" width="670" height="240" border="0" /><p class="caption-text"><div class="media-h-caption">Triage and treatment: At a rural hospital on the outskirts of Jacmel, volunteers, such as nurse Cecile Noel, saw a steady stream of patients in varying degrees of distress.</p></div></div></div></div></div><div> </div><div><p>“My first impression was one of total amazement,” said Ian Greenwald, chief medical officer of the DUHS Preparedness and Response Center and the team leader in Cange, as he recalled walking into the Partners In Health chapel, which had been converted into a hospital ward. “The Haitians were incredibly calm and brave in the face of so much suffering and so many unknowns.”</p><p>Greenwald and his team spent a total of ten days in Haiti, making do without much of the equipment at their disposal in Durham. But for many members of the team, the professional challenges paled in comparison with the emotional impact of the experience. “The sheer number of patients with limb loss, particularly in children, was not something we’re used to,” said David MacLeod, the team’s anaesthesiologist. “Each day, going around the ward and doing dressing changes for children who had lost part of their arm or leg—that, for me, was probably the most striking thing.”</p><p>After several days in Cange, the Duke team moved to the Partners In Health facility in Port-au-Prince, where a broader spectrum of cases—everything from fevers and abdominal pain to gunshot wounds and crush injuries—presented new challenges. “Even then, some people came in with fractures that hadn’t been seen by a doctor since the earthquake,” recalled Katie Sligh B.S.N. ’06, a clinical nurse. “It was three weeks out, and they were just now making their way to a hospital.”</p><p>According to Greenwald, many fracture wounds had become infected by the time patients could be seen. “But amputating was always the last resort,” he said. Greenwald added that while limb loss is a big deal anywhere, amputees in Haiti often face severe discrimination, and that the loss of an arm or leg represents a major economic burden on top of the mental and physical trauma of the event itself. “It was utilized only when the situation was truly life-over-limb,” he said.</p><p>I mentioned to Greenwald that in my conversations with trauma surgeons in Leogane and Jacmel, I’d heard over and over again about Haitians’ remarkable resilience and seemingly superhuman stoicism, and I asked him whether he had encountered the same. “Absolutely,” he said. “Collectively, their pain threshold was just incredible. Throughout our time there, our team was awed by how a patient’s perception of pain seemed to be, in some ways, a social phenomenon.”</p><p>Cameron Wolfe, an infectious-disease specialist with experience in a number of post-conflict and disaster zones, including Timor, Ethiopia, Malawi, and Rwanda, was no less impressed. “The one thing that was the same throughout all of those places was that resilience of the local population,” he said. “Rarely did any effort from our team go without a thank you or a smile, and that was striking to me, given the number of people who had lost not only a limb but often family members, a home, and a livelihood, as well.”</p><div class="media-header flr" style="width: 350px;"><div class="caption caption-center"><div class="caption-width-container" style="width: 350px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-4450531943390f456fcdo.jpg" alt="All hands on deck: names of medical workers taped to clinic door in Leogane" width="350" height="306" border="0" /><p class="caption-text"><div class="media-h-caption">All hands on deck: names of medical workers taped to clinic door in Leogane.</p></div></div></div></div></div><p>Wolfe added that while the Duke team did its best to address short-term threats to health such as tetanus and sepsis and other secondary infections associated with postoperative care, it’s vector-borne and enteric diseases—malaria, dengue fever, and diarrhea—that could ravage displaced populations during and after the rainy season. “That threat is very real,” he said, adding that Haiti’s baseline rates of childhood malnutrition and chronic infectious diseases were already some of the highest in the Western hemisphere. “Tuberculosis and HIV control is a problem in Haiti at the best of times,” he said. “While there’s a concerted effort to minimize the spread of those diseases, there will inevitably be some breaches.”</p><p>In early March, an investigation by the Joint United Nations Program on HIV/AIDS (UNAIDS) revealed a very large breach, and one that could have significant ramifications for population health over the months and years to come: Of the 24,000 HIV-infected Haitians taking anti-retroviral treatment before the quake, less than 40 percent had been able to access treatment in the seven weeks since.</p><p>According to UNAIDS, that was due in part to the fact that the vast majority of HIV-infected patients had been displaced and continued to live in overcrowded tent cities, all but cut off from health-care institutions. Moreover, given that close to 80 percent of camps lacked any kind of management or security infrastructure, the overcrowded communities provided an atmosphere conducive to sexual violence and the STDs that could sweep through in their wake.</p><p>On a rainy afternoon in early March, about five weeks after the quake, I met David Walmer, a physician and associate clinical professor of medicine at Duke, in the Delmas neighborhood of Port-au-Prince, where he had just arrived on a flight from Durham.</p><p>The founder of Family Health Ministries (FHM), a multi-ethnic, faith-based nonprofit organization dedicated to the health and education of women and children in the developing world, Walmer was making his first trip to Haiti since the quake, and he had agreed to show me FHM’s clinic in Blanchard, a ten-minute drive from the airport.</p><p>Built in 2006 with support from Duke Chapel, a longtime FHM partner, the Blanchard Family Health Clinic was the only one of three FHM clinics in Haiti to survive the earthquake unscathed. A volunteer medical team was to begin working there in a few days, and Walmer had brought along the supplies they would need for the thousands of patients they would treat over the next six weeks. “I also just needed to see it all,” he said. “With my own eyes.”</p><p>As chief of reproductive endocrinology at Duke Medical Center and director of the Duke Fertility Center, Walmer has spent much of his career helping couples in the U.S. realize their dream of becoming parents. But ever since his first trip to Haiti seventeen years ago, the North Carolina native has also been an enduring presence among underserved communities in the developing world, particularly poor Haitian women, who tend to be the most vulnerable to disease.</p><p>“We conducted several focus groups last year with women in Leogane,” he told me as the van rumbled over rutted dirt roads, past the American military base and a herd of bone-thin cattle prodded along by a sinewy man in a straw hat. “One of their top priorities was reducing maternal mortality. And they actually formed a women’s group to educate others about the need for cervical cancer screening; they’re extremely invested in this. So we’ve tried to determine how we can use the resources we’ve got to make the biggest possible impact.”</p><p>It was that sort of resourcefulness, combined with a clear understanding of the Haitian context, that led to the development of the “CerviScope,” a portable, inexpensive, battery-operated diagnostic tool Walmer invented for use in settings with limited resources. In the developed world, the devices, called colposcopes, are used to detect abnormal cells in the cervix that signal infection by human papillomavirus (HPV), the primary cause of cervical cancer, which can be treated if caught early.</p><div class="media-header top2 "><div class="caption caption-center"><div class="caption-width-container" style="width: 670px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-450588983425888415efo.jpg" alt="Falling down, getting up: Ob/gyn Delson Merisier in front of what remains of his house." width="670" height="240" border="0" /><p class="caption-text"><div class="media-h-caption">Falling down, getting up: Ob/gyn Delson Merisier in front of what remains of his house.</p></div></div></div></div></div><p>Indeed, in the U.S., where routine screening is widely available, cervical cancer accounts for just over 2 percent of all cancer deaths. Across the developing world, however, a dearth of colposcopes ensures that poor women lack access to screening and that most infections with HPV go untreated. The result is that, every year, cervical cancer kills approximately 230,000 women worldwide, roughly the same number of people killed in the Haiti earthquake, according to the most recent estimate by the Haitian government.</p><p>Still, despite the fact that most, if not all, of those cancer deaths could be prevented, it’s the sudden, seconds-long snuffing out of life that, for better or worse, arrests our attention and moves us to act—to break with our normal routines and to help out however we can. Indeed, when news of the quake reached the Duke campus, the response was massive and immediate, an outpouring of support—financial, technical, and professional—far exceeding any such effort in the past.</p><p>There was the Haitian Student Alliance’s flex-point fundraiser, which brought in $32,000 for the Red Cross, and “Save Haiti Saturday,” an athletics-department initiative benefiting Project Medishare for Haiti. Duke law students raised $1,595 for Doctors Without Borders, while students at the Sanford School of Public Policy raised $2,300 for Mercy Corps. And with the help of Duke staffers, dozens of area restaurants participated in “Dine Out Durham,” raising more than $10,000 for both Partners In Health and Family Health Ministries.</p><p>And that was only the fundraising. There was also a variety of other, non-monetary initiatives—from law professor Guy Charles’ development of a nonprofit agency to support the rebuilding of schools to Romance studies professor Deborah Jenson’s creation of a Creole language course for relief workers to the volunteer program REMEDY’s packing and shipping of 400 boxes of medical supplies to FHM clinics.</p><p>Hardy Vieux ’93 was born in Brooklyn, but he spent his childhood in Port-au-Prince, in the downtown home of his maternal grandmother, not far from the presidential palace. “We used to play near the palace as kids,” he told me over the phone from Washington, where he works as a lawyer with the firm Blank Rome. “When I saw the pictures in the paper that evening—that’s when it really hit me.”</p><p>The president-elect of the Duke Alumni Association, Vieux was in New York for a Duke meeting when the quake struck—exactly six weeks before a planned visit to the city in March. “I had already bought my ticket,” he said. “I hadn’t been back since 1995, and I was really looking forward to seeing family and friends.”</p><div class="media-header flr" style="width: 350px;"><div class="caption caption-center"><div class="caption-width-container" style="width: 350px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-4558229886f4693cbd0do.jpg" alt="Mangine of Haitian Children’s Home feeds dehydrated infant in Jacmel’s largest" width="350" height="322" border="0" /><p class="caption-text"><div class="media-h-caption">Mangine of Haitian Children’s Home feeds dehydrated infant in Jacmel’s largest refugee camp.</p></div></div></div></div></div><p>It was two days before Vieux or his parents heard anything from their relatives in Haiti. Then came the bad news: “We lost family on my mother’s side,” he said. “But we also got news that many others had survived.” One cousin, he said, had a very close call: “He was in a restaurant, and he punched through the window to escape as the ceiling came crashing down. He cut up his leg on the glass, but he was okay.”</p><p>Fluent in Creole, his first language, Vieux figured he could be of help to an organization that might have him along. He eventually got in touch with Kathy Walmer, FHM’s executive director, whom he’d learned about through Duke’s Haiti Relief website.</p><p>Walmer, a pediatric nurse practitioner, was preparing to take the first post-quake medical team to the clinic in Blanchard, and she welcomed Vieux along. “Sixteen of us met up in Miami,” he recalled. “And we arrived at the clinic that night.” In the days that followed, Vieux tracked down family and friends in Port-au-Prince, and found that all of those who had survived were now displaced, their houses, as well as the one he grew up in, damaged or completely destroyed. “It was a difficult week,” he said. “But at the same time, it was heartwarming to see such selflessness in action and so many Americans helping out on the ground. As a Haitian-American, it made me extremely proud.”</p><p>For Kathy Walmer, the trip was exhausting. The Blanchard clinic saw 1,508 patients, “a one-week record that I do not care to break in the near future,” she wrote on the FHM blog. Walmer also went to Fondwa, a mountain village on the road to Jacmel, where FHM has a school. “The school is a total loss,” she told me afterward. “Fortunately, though, the kids had gone home by the time the quake hit.”</p><p>On one of my last days in Haiti, I joined Delson Merisier, an adjunct professor of medicine at Duke and FHM’s head ob/gyn, for an afternoon in Leogane, the epicenter of the earthquake. Ninety percent of the town’s structures had been affected, and piles of rubble lined the streets, the smell of dead bodies still strong in the places the Canadian soldiers had yet to reach. Merisier showed me into FHM’s satellite outpatient clinic, where he’d delivered a healthy baby moments before the second floor came tumbling down on the first.</p><p>“I was standing right here with the patient,” Merisier said, as we entered a blue room with a single crack dividing the ceiling into halves. “Her husband was there, next to the bed. So I picked up the patient, and I told the husband, ‘Run!’ And he ran—but he left the baby! We got outside, and I said, ‘Where’s the baby?’ He said, ‘I left it inside!’ I said, ‘Why did you do that?’ He said, ‘I don’t know!’ So I ran back in.</p><p>“Everything was moving—the walls, the ground, the tables, the chairs—back and forth, back and forth. It was so hard to stay up. I kept falling down and getting up and falling down.” Merisier told the story with his whole body. When he said the ground moved, he lifted his arms up and down and bent his knees. And when he said he was standing in a certain spot, he put his foot down hard, as though he needed to convince me that it all really happened, that it wasn’t a dream.</p><p>Miraculously, Merisier and his wife, who is also his head nurse, survived unharmed, along with their three kids and the baby he had just delivered. Their house, however, did not. Showing me through what had been his living room, Merisier stepped carefully over tangled rebar and chunks of concrete and stopped at the edge of a gaping hole. A pair of goats stared down from atop a felled wall, and a hen scuttled by. Merisier paused and bent over to pick up an egg hidden in a pocket of rubble.</p><p>“Nobody ever said, you know, ‘You need to be careful, an earthquake is coming.’ Nothing like that—no warning,” he said. “Then it came, and we lost everything.” Merisier shook his head and gave a small laugh, as if to say, “What can you do but keep going?”And that he has. Days after the quake, Merisier, one of Leogane’s two resident ob/gyns, was back in the shattered clinic, delivering babies. “But this time I was careful,” he said. “I put the bed right next to the entrance in case we had to escape.” Before I left, Merisier drove me by the ten-acre site of what will someday be the Leogane Family Health & Research Center. Construction had been planned to occur in phases—lasting up to ten years—as funds became available. But after the earthquake, which toppled the area’s only other hospital providing surgical care, the Walmers began lobbying USAID for an out-of-cycle grant, hoping to build it instead in just two years.</p><p>“It’s going to be right here,” said Merisier, stopping the truck. In front of us, rows of banana trees stretched as far as the eye could see.</p><p class="byline">Adams ’01, a former Clay Felker Fellow at <span class="pubtitle-nonital">Duke Magazine</span>, holds a master’s of public health from Emory University. A freelance journalist based in Atlanta, he has written for the World Health Organization, the Centers for Disease Control and Prevention, and <span class="pubtitle-nonital">The Lancet.</span></p></div></td></tr></tbody></table> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2010-06-01T00:00:00-04:00">Tuesday, June 1, 2010</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/dm-main-images/050610-lg-4505889862369a4e4d7co.jpg" width="670" height="362" alt="Shelter from the storm: Volunteer nurse monitors a three-year-old girl with two broken legs in mobile operating room in Leogane. Photos courtesy of Patrick Adams." /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/may-jun-2010" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">May - Jun 2010</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue<section class="field field-name-field-sub-header field-type-text-long field-label-above view-mode-rss"><h2 class="field-label">Sub-header:&nbsp;</h2><div class="field-items"><div class="field-item even">In the wake of Haiti’s devastating earthquake, an alumnus discovers the enduring resilience of the country’s residents—and the ongoing efforts of the Duke community to respond to their needs.</div></div></section> Tue, 01 Jun 2010 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500782 at https://alumni.duke.edu After the Shock https://alumni.duke.edu/magazine/articles/after-shock <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <div class="caption caption-center"><div class="caption-width-container" style="width: 300px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-img0318.jpg" alt="Ties that bind: Dzau with Partners In Health staff members at Cange pediatric clinic" width="300" height="399" border="0" /><p class="caption-text"><br /><div class="media-header fll " style="width: 300px;"><div class="media-h-caption">Ties that bind: Dzau with Partners In Health staff members at Cange pediatric clinic. Credit: Ian Greenwald</p></div></div></div></div></div><p class="articletitle">On March 2, Victor J. Dzau, chancellor for health affairs and CEO of Duke University Health System, made his first visit to Haiti. A close friend and former colleague of Paul Farmer ‘82, Dzau had gone to support fourteen Duke medical volunteers deployed to assist the Partners in Health staff in Cange.</p><p>But he had also gone to assess the situation on the ground—and to determine how Duke Medicine could best help Haiti in the months ahead. He came away, he said, inspired by the “incredible spirit of the patients and aid workers,” but also staggered by Haiti’s enormous needs.</p><p>“The facilities in Port-au-Prince were destroyed, and the huge demand for emergency surgery and follow-up care spilled over into rural areas,” Dzau told me, explaining how the country’s health inequalities had exacerbated the effects of the earthquake. “Those rural areas lacked the manpower and the resources to respond, so the crisis put a tremendous burden on the country as a whole.”</p><p>One strong measure of a national public-health system is its ability to protect people from what are known as vaccine-preventable diseases (VPD). With a mere 43 percent of its population immunized against VPDs, Haiti lags far behind the rest of the region, putting earthquake victims at elevated risk of infection.</p><p>Take tetanus, said Dzau. “Most people have not been vaccinated for it, and now we’re seeing an increase in cases in people who have undergone surgery. They’re discharged from the clinic and return home. But ‘home’ is a tent or tenement, with no clean water or sanitation.”</p><p>As the Duke team attended to Haiti’s acute medical needs, Dzau and Farmer met with government officials and senior health-care leaders to discuss the country’s long-term challenges, among them educating Haiti’s future doctors and nurses. “Here the Haitians were very clear,” said Dzau. “They plan to work with McGill University to develop a curriculum tailored to the country’s particular needs. I think our job will be to support them with resources, but not to try to reinvent the system.”</p><div class="media-header fll " style="width: 300px;"><div class="caption caption-center"><div class="caption-width-container" style="width: 300px;"><div class="caption-inner"><img src="/issues/050610/images/050610-lg-haiti023.jpg" alt="Nurse anaesthetist Lee Freeman with young patient" width="300" height="332" border="0" /><p class="caption-text"><div class="media-h-caption">Nurse anaesthetist Lee Freeman with young patient. Credit: Ian Greenwald</p></div></div></div></div></div><p>On the day I talked to Dzau, representatives of 138 donor countries assembled at U.N. headquarters in New York, where they pledged to “build back Haiti better” with $5.3 billion in funding over the next two years. Still, said Dzau, aid alone can’t solve Haiti’s problems. “The real problem that I see at this point in time is a lack of coordination and a lack of authority. There are a lot of NGOs there, and there’s confusion about what different groups are doing. Going forward, it has to be coordinated; it can’t be many individual do-gooders doing their own thing.”</p><p>No less important, he said, is the willingness of donor countries to work with the Haitian government. “The government has always had limited resources. But many of the donations, as well as funding from the U.S. government, are going to NGOs, not the government,” he said. “That is a real problem. So the question is, how can academic institutions like Duke help to find the funding to enable the government to do its job?”</p><p>On April 5, the third Duke Medicine volunteer team arrived in Haiti to assist the Partners In Health staff in both Cange and Port-au-Prince.  And while a formal Duke-PIH partnership has yet to be established, Dzau says there is strong interest on both sides in forging longer-term ties. “There is a great deal to be done down the road, including rebuilding the medical and nursing schools.”</p><p>For now, he says, Duke Medicine is committed to maintaining its support for PIH  “We’re sending medical teams every month for the next six months,” he said, adding that even as surgeries taper off, Haiti’s medical needs remain immense. Dzau pointed out that all members of the Duke teams volunteered to work in Haiti, and that Duke Medicine is covering their expenses, which are considerable. “We felt that this was best. These are all people who want to be there, and they’re working day and night for as long as they’re on the ground.”</p> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2010-06-01T00:00:00-04:00">Tuesday, June 1, 2010</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue Tue, 01 Jun 2010 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500777 at https://alumni.duke.edu Compassionate Conservation https://alumni.duke.edu/magazine/articles/compassionate-conservation <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top"><p class="articletitle">For Stuart Pimm and his group of graduate students, the trip always begins the same way--with furious last-minute packing, a visit to CVS for anti-malarials, and a final powwow in the Nicholas School of the Environment and Earth Sciences.</p><p>Where it takes them, though, may be to a Madagascan jungle or an Everglades prairie or the savannahs of southern Africa. Such are the far-flung field sites that Pimm, Doris Duke Chair of Conservation Ecology, visits regularly to oversee his team's work. A mix of doctoral and professional students--Pimm calls them his "family"--they study the various threats (all human) to the planet's variety of life and what, if anything, can be done to curb current trends.</p><p>"We are killing off species at between 100 and 1,000 times the natural rate," says Pimm. "I think we're likely to lose 25 to 50 percent of them over the next century." He says that prompts the question, "What is our moral responsibility?"</p><p>In Pimm's view, the crisis is both an ethical and an ecological one, and only by immediately protecting what he calls the "special places"--the areas richest in biodiversity and most directly in the path of human advance--can we hope to avert it. That's a message he's sought to spread to his scientific peers, policy-makers, and the public alike. Pimm is an academic scientist, indeed one of the world's foremost experts on theoretical ecology. But he is a problem-solver in practice, a prime example of what, last Founders' Day, President Richard H. Brodhead described as Duke's "real-world orientation."</p><p>Last July, Pimm was in the real world's biggest rain forest, the Brazilian Amazon, where he and his team began a two-week journey to the frontline of conservation and the frontiers of the natural world. Along the way, they would make a stop in Brasilia, the nation's capital, for the nineteenth annual meeting of the Society for Conservation Biology (SCB), where Pimm would confer with colleagues, and his students would present their work. That organization has special significance for him. "Back in the Seventies, there was no such thing as 'conservation biology,' " he says. "Conservationists were advocates, not scientists." It was after the SCB's inaugural meeting in the mid-Eighties that, as he puts it, "I knew what I was."</p><p>Over breakfast at his hotel in Manaus, the chief commercial hub of the upper Amazon basin, Pimm appeared exhausted. He had flown in that morning from the Roraima region to the north, where he'd accompanied one of his students, a Brazilian named Mariana Vale (pronounced VAH-lee), into the field. For months, Vale had been tracking the Rio Branco Antbird, one of the world's rarest and most threatened species of birds, on her computer at Duke. Using satellite images, she had mapped its habitat--vegetation and elevation--in a patch of forest just south of the Venezuelan border. She'd searched museum records for information on previous sightings--the few that there were--and plotted what she believed to be the bird's geographical distribution.</p><p>But Vale could only make guesses from her desk in Durham. To confirm anything, she'd have to see it with her own eyes, to "ground-truth" it, as Pimm put it. "At some point," he said, "you have to make sure that what you're seeing on the image is really what is there. You have to go."</p><p>So they went--first to Caracas, Venezuela, and then by taxi across the country--down through the Orinoco basin, up the highlands of the Guyana Shield, past the giant sheer-faced tepuis that inspired Sir Arthur Conan Doyle's novel The Lost World, and, finally, over the border into Brazil, to a town called Boa Vista. From there, they traveled ten hours up the Uracoeira River, a tributary of the Amazon, in an open boat under the blazing equatorial sun. They slept in hammocks draped with mosquito netting to ward off malaria and caught catfish for dinner.</p><p>For Pimm, the conditions were nothing new; he has been to the field with each of his students on at least one occasion. Usually the goal is the same: to find a bird. If that seems like a small reward for the investment made and the risks assumed--death by snakebite and lethal infection being among the more likely life-ending scenarios--consider the bird's scientific significance. "They're our window into what is happening to the rest of the environment," Pimm explained. "Few groups of plants and animals have catalogues as complete. We know them--how many there [are] and where they are--very well." That's a product of the public's passion, he said--birdwatchers the world over have given science a useful tool.</p><p>Still, he added, tools and know-how alone won't prevent extinctions. "We need to train more conservation professionals," he said. "You can't set up a protected area without people to look after it. Just like politics is local, conservation is local. So wherever my group goes, we're working with the community. We don't go as uninvited gringos. We go to provide expertise to the people who will ultimately be making the big decisions, who will shape policy."</p><p>For the past decade, Pimm's team has collaborated with the Brazilian government's National Institute for Amazonian Research (INPA) in Manaus. Paired with INPA scientists, they've contributed findings to one of the institute's core programs, a joint research venture with the Smithsonian Institution called the Biological Dynamics of Forest Fragments Project (BDFFP). The BDFFP is the brainchild of a scientist named Thomas Lovejoy, formerly the senior biodiversity adviser to the president of the United Nations Foundation and the man generally credited with bringing deforestation of the tropics to the public's attention.</p><p>Almost thirty years ago, Lovejoy embarked on an ambitious ecological experiment in the rain forest north of Manaus. He wanted to find out what happened to a rain forest when it was broken up into fragments--the leftovers of clearing--and how small a fragment could be and still function. He speculated that a key theory of island bio-geography--namely, that a small oceanic island can support fewer species than a larger one--might apply to these "islands" of forest, surrounded as they were by farms and cattle pastures.</p><p>After two decades of monitoring a sample of fragments ranging in size from 2.5 to 250 acres, a group of ecologists assessed the results. Lovejoy was right: In every one, the diversity of palm trees, euglossine bees, butterflies, dung beetles, termites, birds, and primates had declined. Pimm chaired that assessment and, afterwards, wrote the report. By the time the results came out, it was no longer controversial, he wrote, to say that small, isolated fragments lose species. "Deforestation has provided many examples worldwide." But what was new, and what would give added urgency to future conservation efforts, was how quickly the losses were happening.</p><p>Following that assessment, Lovejoy asked Pimm to help him with the project. He needed people who could analyze the loads of data, publish papers, and generate more science. And Pimm, he knew, had the students for the job: smart, tough, young researchers with experience in the field.</p><p>Kyle Van Houtan, a current member of Pimm's "family" of graduate students, already had his field scars when he came to pursue his Ph.D. under Pimm in 2002. As a master's candidate at Stanford University, he'd studied parrots and macaws--curious for their clay-eating habits--on a river in southeastern Peru. After three months in a place locals called El Infierno (Hell), he noticed a sore on his leg that wouldn't go away. A trip to the doctor revealed Leishmaniasis, a potentially fatal disease spread by the bite of the sand fly. The treatment was a month of chemotherapy.</p><table width="324" border="0" cellspacing="11" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/010206/images/lg_urntpatch.jpg" alt="Pimm: examing deforestation in Canaima National Park near Venezula-Brazil border " width="580" height="318" /><p class="caption-text"> Pimm: examing deforestation in Canaima National Park near Venezula-Brazil border</p></div></div></div></td></tr></tbody></table><p>Van Houtan's research for the BDFFP focuses on the characteristics that predispose certain birds to disappear from the fragments more quickly than others. But that is only his scientific side. He is also pursuing a master's in Duke's Divinity School, and while Pimm and Vale headed for the remote upper reaches of the forest, he embarked on a taxi tour of Manaus. His aim, he said, was to reach out to local Christian leaders, mainly pastors and missionaries, and to urge them to address environmental issues in their church.</p><p>"I've really come to believe that the fundamental obstacle to stopping this crisis, to preventing the loss of biodiversity, isn't a lack of science. It's a lack of will. It's an ethical issue," he said, as the taxi sped across town, passing stacks of timber and signs offering the services of borracheros (rubber repairmen), evidence of the rubber boom that built this urban island in the jungle. "But a lot of people don't see the environment as something that involves them," he continued. "They don't see themselves as a creature."</p><p>For Christians, Van Houtan said, "that's a huge irony. The Creation Story ends with humans being made--in a garden. The Bible actually talks about this. It's not blatant. But it's there." Take Colossians, he said:</p><p>"'For by Him were all things created, that are in heaven, and that are in Earth.' That's all of this. God made it, and it's good, and he gave us the tools to preserve it."</p><p>That afternoon, Van Houtan spoke to the local director of New Tribes Missions, a nondenominational missionary group. The director had moved to Manaus from Oklahoma more than a decade ago to bring the Gospel to indigenous tribes living in the forest. Since then, he said, things had changed. "The fish are getting smaller. So now the way the Indians sometimes catch them is by using dynamite. Or poison. They'll pour it in the water, and it ruins that part of the river. But they know they'll get enough to eat that day."</p><p>Van Houtan came away from the meeting with a new idea. He wants to produce manuals on natural history and ecology for missionaries to use as they teach native populations. "This would help them understand what they see around them every day--why a sloth is green, for example, or why a parrot will eat clay," he said. "It's offering them something they value. They see themselves as part of nature--which we all are, of course. They just 'get it' better than we do."</p><p>After two hours on the highway, north from Manaus, the truck turned onto a narrow dirt road. It was Pimm's last night in the area--the next day he'd head for Brasilia, for the conservation biology meeting--and he'd arranged an excursion to the canopy, the forest's topmost stratum, "the biologically least known part of the planet."</p><p>Two Brazilian scientists from INPA agreed to take Pimm into the forest, and one of them, an ornithologist who identified himself only as Marcos, drove the truck, dodging ruts and powering up hills. "You have to stay in the middle," he said at one point. "Sometimes the caiman is sleeping in the bog on the side."</p><p>The road went east for almost thirty miles to an INPA research camp, an open-air structure just off the road. After a meal of fish and rice, Pimm discussed the plan for the morning: arise at 5:00 and then hike to the tower, a 150-foot steel observatory, about a mile away. INPA scientists use the tower to conduct species censuses and to measure carbon levels in the atmosphere. Pimm wanted to show off the view.</p><p>In the morning, Pimm led the way. It was still dark, and the forest was almost silent. Turning a headlamp to either side of the trail revealed the dizzying complexity of the surroundings--mammoth tree trunks with roots like buttresses, tangles of lianas, and enormous oblong leaves that hid the moonlit sky from view. Along the path, patches of phosphorescent bacteria glowed like stardust, and a ground cover of decomposing leaves filled the air with a rich odor of humus.</p><p>In The Voyage of the Beagle, Charles Darwin's 1837 account of his first encounter with the tropics, the experience that would set him on the road to Origin of Species, he reveled in the "bright green foliage" and the "elegant curvature of the fronds," and he marveled at the ants--"the lion-hearted little warriors"--that he observed as they blanketed the forest floor in search of prey. "It is easy to specify the individual objects of admiration," he wrote. "But it is not possible to give an adequate idea of the higher feelings of wonder, astonishment, and devotion, which fill and elevate the mind."</p><p>Darwin was overcome. And yet he'd only seen the beginnings of the system, a network so intricate that, long after the age of discovery, just a tiny fraction of its many parts are known. Above him, in the treetops, was another world altogether, the forest's canopy. Darwin hadn't the means to get there--but Pimm had.</p><p>"Look out there and pick a tree," said Pimm. He was winded from the climb, and his shirt was soaked in sweat. "Pick any one. And then try to find ... (deep breath) ... another one ... like it." He was offering a lesson in biodiversity. Out there lay a living patchwork, a green expanse wreathed in mist and extending to the horizon. Many a trained professional botanist had failed, he said. "You simply cannot do it."</p><p>Indeed, here, high above the sandy soil, was what has been called the last great unexplored frontier of the natural world. In only the two hectares below, said Pimm, were more species of trees than in all of eastern North America. On any one of them, there might be a thousand species of insects, a hundred species of fungi, spiders no one had ever seen, unidentifiable frogs living in the cistern-like crowns of equally unidentifiable epiphytes. No one really knew.</p><p>Stuart Pimm was born in Derbyshire in the north of England. His father was a factory worker in the local Rolls Royce plant and his mother kept the house. Growing up, he was small and slight, precocious and bookish. "I was not a sportsman," he says. "I liked to read, and I liked birds."</p><p>Pimm was twelve years old when he went on his first field trip with the Derbyshire Ornithological Society and glimpsed, to his amazement, a gold finch. "That," he recalls, "was the first. I was hooked." He became an avid birdwatcher. He kept a "life list" of the species he'd seen and was always seeking more.</p><p>As an undergraduate at Oxford, he studied ecology and spent two summers doing field work in Afghanistan. After graduating, he went to New Mexico State University, where he earned his Ph.D. in 1974, and where he encountered the peculiarities of a different culture. "Someone kindly explained to me shortly after my arrival that the smallest coin was worth twice the amount of the medium-sized coin."</p><p>As a young scientist, Pimm was eager to do his research in a pristine setting "in order," he says, "to understand how nature really works." It didn't matter to him whether it was desert or rain forest, only that it was utterly untouched, an ecosystem in its purest state. Hawaii was not such a setting--far from it; decades of tourism had altered the islands in major ways, killing off many of the native species. But that's where Pimm ended up, on a project that had originated in New Mexico. He'd been studying the dynamics of southwestern hummingbird communities when he heard that Hawaii's honeycreepers behaved in a similar way.</p><p>The honeycreepers, Pimm learned, were also on the verge of extinction, and it was then, he recalls, that "something changed." Well on his way to a successful career--by the time he was twenty-nine, he had published five papers in Nature and Science--he suddenly realized, he says, "that science wasn't enough." He wondered whether, in twenty years, "people would not look back and ask, 'What were you doing while all these species were going extinct?'" Instead, he embraced "science with a sense of responsibility."</p><table width="100%" border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/010206/images/lg_onboat.jpg" alt="River trip: Vale and Pimm, with guide Claudiomiro Parente, on Uraricoera River" width="580" height="291" border="0" /><p class="caption-text"> River trip: Vale and Pimm, with guide Claudiomiro Parente, on Uraricoera River</p></div></div></div></td></tr><tr><td class="tenpxtextblk" align="center"> </td></tr></tbody></table><p>Pimm is an animated lecturer. In a speech last spring at the Nicholas School's Student Conference on Con-servation Science, he was electric, stomping and jumping and pounding the podium. "Washington, D.C., is an appropriate place to do conservation biology," he told the audience. "The animals that live there are worthy of our attention!"</p><p>It was one zinger after another, and there was plenty of substance to the show. Pimm appealed to his audience, students from all over the world, to go beyond the laboratory, beyond the insular world of research, and to advocate on behalf of their work. "We have to do our conservation everywhere," he told them. "You are sexier and more intelligent than the lobbyists who reside in the corridors of power. Be nice to your politician."</p><p>He recalled his own efforts--the time he testified before a Senate subcommittee on the reauthorization of the Endangered Species Act--and offered advice on dealing with the media, "who have an uncontrollable urge to present both sides." And finally, his fists raised in the air, Pimm left the crowd with a raucous reminder: "It might not be what you work on that matters," he boomed, "but how angry you get at what is happening to the places about which you care!"</p><p>Months later, at the conference in Brasilia, people were angry about all kinds of things: the effects of boat noise on whale communication in the Pacific, the consumption of bushmeat in Cameroon, the status of Myanmar's elephants and Mexico's jaguars and the hairy wood ant Formica lugubris of northeast England.</p><p>Mariana Vale, Pimm's student, however, was beaming. On her trip to the field with Pimm, she'd found her Rio Branco Antbird--by playing a tape-recording of the male's call and then listening for another very territorial male's answer--and extended its known range. "One thing I found is that the bird lives in indigenous reserves. So I'm trying to get those communities involved in protecting it." That poses a very different challenge, she said. "Working with birds, I can go once a year for a month. They don't have to remember me. But people do. This takes trust and time. We do little things together. They want a workshop on identifying birds and a field guide with Portuguese names. So I'm working on that."</p><p>After the meeting, Pimm flew to Rio de Janeiro, Vale's hometown and the last stop on his trip. Two years ago, Pimm had come here on a research expedition supported by the National Geographic Society. He and Brazilian ecologist Maria Alice Alves had boarded a helicopter in Rio and flown a few miles inland. They were searching for the gray-winged cotinga, a bird believed to exist on only two mountaintops along a treacherous ridge. Rare and on the brink of extinction, it shared the plight of its neighboring endemic species in Brazil's Atlantic Forest.</p><table width="100%" border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/010206/images/lg_dscn0683.jpg" alt=" " width="580" height="294" border="0" /><p class="caption-text">Bird in the hand: the elusive Rio Branco Antbird</p></div></div></div></td></tr><tr><td class="tenpxtextblk" align="center"> </td></tr></tbody></table><p>Pimm considers protection of the Atlantic Forest to be among the world's most pressing conservation priorities. The forest was once an unbroken swath nearly twice the size of Texas; only 6 percent of it still stands. Pimm chronicled the expedition for National Geographic. "Someone has to go," he wrote, "not 'because it's there,' but precisely because in short order it may not be." The helicopter landed, and the scientists began their search. But Pimm never saw the bird. Alves later told him that she'd heard its call. But to the birder in Pimm, that was hardly consolation. The fact remained; he had not seen it.</p><p>This time he went by jeep. It took three hours to get to the mountain and another to get to the top. It was cold and drizzling, and, after an hour of scouring the trees, he hadn't seen a thing. Soon the drizzle turned to rain, and the ground to mud. And then came a call, a short, high-pitched whistle. "That was it!" said Pimm. Something darted across the trail, then flew back into the brush. No one could make it out. Silence. Then another call, from behind. And there, perched on a waist-high shrub, was an unexceptional looking bird, greenish-gray and small. Had it flown into a grocery store in Rio, no one would have noticed. But Pimm couldn't take his eyes off it. He stood there smiling as the bird hopped from branch to branch.</p><p>Suddenly, somewhere beyond the mist, chainsaws buzzed. The bird lifted its wings--perhaps it recognized the sound--and then, once again, it was gone.</p><p class="byline"><em>— Adams '01, a former Clay Felker Fellow at Duke Magazine, is a freelance writer living and teaching in Colombia. Fattal '01 is director of special initiatives at the AjA Project and a freelance photographer.</em></p><div> </div><span class="text"></span></td></tr></tbody></table> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2006-01-31T00:00:00-05:00">Tuesday, January 31, 2006</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/dm-main-images/lg_lenses.jpg" width="620" height="276" alt="Profiling Pimm&#039;s team: Videographer Peter Jordan &#039;01 films graduate student Mariana Vale on flooded road in Brazil" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/jan-feb-2006" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Jan - Feb 2006</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue<section class="field field-name-field-sub-header field-type-text-long field-label-above view-mode-rss"><h2 class="field-label">Sub-header:&nbsp;</h2><div class="field-items"><div class="field-item even">Ecologist Stuart Pimm feels a moral responsibility to protect the world&#039;s &quot;special places&quot;--those richest in biodiversity and most threatened by human advances. Photos by Alex Fattal.</div></div></section> Tue, 31 Jan 2006 10:00:00 +0000 Joseph Sorensen, JOSEPH E. 18502081 at https://alumni.duke.edu Eye in the Sky https://alumni.duke.edu/magazine/articles/eye-sky <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top"><table border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/010206/images/lg_patadamsrio3d.jpg" alt=" " width="580" height="295" border="0" /><p class="caption-text">Zeroing in: satellite images, from continent to forest</p></div></div></div></td></tr><tr><td class="tenpxtextblk" align="center"> </td></tr></tbody></table><p class="articletitle">Almost as soon as he arrived in Rio de Janeiro last July, Clinton Jenkins was robbed. He was riding a city bus when a man swiped his laptop computer and made for the door. Had the thief cared to inspect the contents of his new computer, he might have been surprised, and a bit concerned, by what he found: satellite images of Rio and the Atlantic Forest that surrounds it. Had he robbed a spy?, he might have wondered.</p><p>Jenkins is not a spy. He is a postdoctoral researcher who works with conservation ecologist Stuart Pimm, specializing in remote-sensing technology. He'd been teaching a course on remote sensing and geographical information systems (GIS) to conservation professionals at the Brazilian Institute for Ecological Research in nearby São Paulo that summer. The rest of the year, he assists his colleagues in the Nicholas School of the Environment and Earth Sciences at Duke.</p><img src="/issues/010206/images/lg_mssouthamerica.jpg" alt="Zeroing in: satellite images, from continent to forest " width="300" height="193" align="left" border="0" hspace="10" vspace="10" /><p>As a concept, remote sensing is simple: It's the observation of any object from a distance. But when the object is the Earth and the distance is space, the observing gets a bit tricky. "You have to make the image interpretable," says Jenkins, "you have to get the colors right." The colors are the wavelengths of electromagnetic radiation reflected by objects on the ground (plants, trees, rivers, roads). Those wavelengths are recorded by the satellite as digital numbers, which are then transmitted to Earth, where scientists like Jenkins enter the data in a computer program to produce an image.</p><p>The satellites have the capacity, Jenkins explains, to distinguish between ranch and farm, grass and forest. Even among trees, the wavelengths vary. Levels of chlorophyll, the chemical in leaves that absorbs visible light, are higher in some trees than in others. But the satellite's most powerful feature, he says, is that it captures infrared light as well. "Infrared light isn't absorbed by the forest. So you get this very distinct signature of vegetation."</p><img src="/issues/010206/images/lg_srio3doom.jpg" alt="Zeroing in: satellite images, from continent to forest " width="300" height="200" align="right" border="0" hspace="10" vspace="10" /><p>That's critical if, like Nicholas School graduate student Mariana Vale, you want to map a specific bird's habitat. Before leaving for the field, Vale knew from existing literature that the Rio Branco Antbird lived in gallery forest along a tributary of the Amazon. And the images she had analyzed indicated the presence of that vegetation. Once there, she recorded the Global Positioning System (GPS) points where she spotted the rare species. Back at the Nicholas School weeks later, she entered the data into a GIS program, which all Nicholas School computers are equipped with. Through the GIS, she could superimpose the bird's distribution onto a map of hydroelectric projects in the area and look for intersections between the two. The picture, she says, is not a pretty one.</p><p>Broadly speaking, satellite imagery is a picture that conservation cannot do without. Since they were first made available to the public in the early 1970s--when NASA launched the first of its low-orbit Landsat satellites--digital images of the Earth's surface have been more than a scientific resource. They've created global awareness of environmental crises and driven action at the national level. A landmark study in the journal Science in 1993 measured deforestation of the Amazon through a collection of more than 200 images taken between 1978 and 1988. "That really got people's attention," says Jenkins. "It was the first time anyone said, 'Look, this is what is happening on a massive, continental scale. It's not a myth.'"</p><img src="/issues/010206/images/lg_pamsroraima.jpg" alt="Zeroing in: satellite images, from continent to forest " width="300" height="193" align="left" border="0" hspace="10" vspace="10" /><p>Indeed, in addition to their scientific applications--soil surveys, mineral exploration, mapmaking, and many others--satellite images put the planet, in a sense, on public display. Anyone with access to the technology could keep an eye on the situation, monitor the progress of development projects, and report illegal activity.</p><p>Over the past year, Jenkins has been keeping tabs on the movements of two oil companies in the Ecuadorian Amazon. "You can see how close the road comes to the indigenous reserve," he says of one. "They've already broken their promise as to how close they would get." If he sees that road go further, Jenkins says, he'll notify the press. "The fact is, they may break laws, but whatever they do, the world's watching."</p><p> </p><p> </p><hr align="center" noshade="noshade" size="1" width="85%" /><pre style="font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </pre></td></tr></tbody></table> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2006-01-31T00:00:00-05:00">Tuesday, January 31, 2006</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue Tue, 31 Jan 2006 10:00:00 +0000 Joseph Sorensen, JOSEPH E. 18502078 at https://alumni.duke.edu Malpractice, Insurance, and the Feds https://alumni.duke.edu/magazine/articles/malpractice-insurance-and-feds <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"><table border="0" cellpadding="2" cellspacing="0" style="width:98%"> <tbody> <tr> <td> <table align="center" border="0" cellpadding="1" cellspacing="10" style="width:224px"> <tbody> <tr> <td> <div class="caption caption-center"> <div class="caption-width-container" style="width: 580px;"> <div class="caption-inner"><img alt="Sloan: the injustice of caps" src="/issues/050605/images/lg_sloa0421.jpg" style="height:241px; width:580px" /> <p>&nbsp;</p> <p>Sloan: the injustice of caps. Les Todd.</p> <p>&nbsp;</p> </div> </div> </div> </td> </tr> </tbody> </table> <p><strong>The U.S. spends $1.65 trillion a year on health care--15 percent of its gross domestic product. The culprits, says President Bush, are large medical malpractice awards. He has proposed legislation that would cap awards for noneconomic damages at $250,000. But plaintiffs' lawyers and consumer groups have raised questions as to just how effective such legislation would be in reducing costs. Frank Sloan, J. Alexander McMahon Professor of health policy, law, and management at Duke, comments on the dynamics of the debate and the complexities confronting a lay public.</strong></p> <p>On the one hand, you have President Bush and the American Medical Association blaming "frivolous lawsuits" and malpractice awards for the spiraling costs of health care. But we see studies, including a recent one by Duke professors looking at Florida, that suggest that it's not the lawsuits but market dynamics and the business practices of insurance companies. Which is it?</p> <p>First of all, Bush doesn't know if they're frivolous or not because he hasn't looked at them. Secondly, let's assume that health-care costs are high because of medical malpractice. Let's pick a number. Let's say they're 25 percent too high. And let's put in anything you want to get these costs under control. Now what happens the next year? The next year, patients are not having the tests, the surgeries, they're not being hospitalized. Demand is down by 25 percent. You go by clinics, and they're boarded up. Boy, these guys are really altruistic! That they're actually advocating a loss of business? Now who would do that? Would the university? Would they say, we're in favor of something that would cut out a quarter of our students? No way. So there's some truth to both sides.</p> <p><strong>But awards are increasing?</strong></p> <p>Yes, but they're creeping up. And that's not consistent with the jerkiness in the pricing of coverage by insurers. At its outset, malpractice insurance was largely a state market. The idea of the enterprise was not to make a big business. It was to provide affordable and reliable coverage to the physicians in that state. But then, companies got the idea that business was so good they were going to go out of state and become big. It's sort of like what you see with the Baby Bells. And in order to get business, to get a physician to talk to them, they had to say, Hey, come to me, I can offer you a better price. They got aggressive, and they underpriced their coverage. And now they have to catch up. They spiked prices in 2002. But they probably should have been raising them all along.</p> <p><strong>Would the caps Bush is proposing be effective?</strong></p> <p>Caps will reduce premiums and reduce losses. There's plenty of evidence to support that. That doesn't mean they're just. But it means that if you want a tool to reduce premiums and losses, there's nothing like a damage cap. I feel very confident about that.</p> <p><strong>When would $250,000 not be a just award?</strong></p> <p>Here I am, a kid, and my brain was deprived of oxygen. And I'm not too smart. And I can't walk real well. And I need therapy my whole life; my family has to watch out for me all the time. Now, it's not that I didn't get into MIT, and therefore I'm suing. It's that I'm in bad, bad, bad shape. And I'm going to live as long as you are.</p> <p>Basically, the little cases have little damage, and they're way below the cap. So you're talking about me. And if you cap it at 250, you're cutting me off. You could say, Well, you're getting all your economic loss. And you're only limited to $250,000 on the other side. But what I'm getting are nominal dollars. So I have this life of suffering. And I don't really have the money to take care of myself.</p> <p>So when I look at the injustice of caps, I would say, they're not indexed for inflation. This is a real problem. Who would like to be in a business in which you said, 'Hey, buddy, this is your salary, and we're not increasing it'? If we wanted to apply that principle elsewhere, we could apply it to doctors. In fact, you know, that sounds like a great idea for cutting costs. Put a cap on their salaries. I mean, it's identical, right? It's public policy. Cap 'em. Federal cap 'em. No doctor should earn more than $300,000. You can raise your kid. Fine. We're paying more for health-care costs than any other country, so what's wrong with that? And you could say, But, people will be hurt. Well, we're not asking if people will be hurt by caps, are we?</p> <p><strong>How are doctors faring now? Are the higher premiums driving them out of business, as Bush has charged?</strong></p> <p>Let's say I'm a practicing doctor, and I'm having trouble with managed care. And I'm having trouble with the government, and nobody wants to raise my fees. And then along come the medical-malpractice insurers raising the premium 40 percent. Well, that really cuts in deep, cuts into my income. So, of course I cry out, and I look to the government to intervene.</p> <p>But are doctors leaving? I've heard that so much. Everybody can tell you an example of a doctor leaving. And I don't think they're lying. But it's not the case across the board. In North Carolina, between 2002 and 2003, the number of doctors increased. Now, they may have increased more before. But I think if you were to look at other industries in the state, I don't think in any of them have we seen increases in employment. So it's awfully hard for me to turn an increase into a decrease. In Pennsylvania, for instance, they say that obstetrician-gynecologists are leaving. Now it could be that some of them aren't delivering babies, but the number of them actually went up between 2002 and 2003. So these numbers can be used any way you want to use them. It could be that a doctor left, and another doctor bought his practice and moved in. So the fact that he left doesn't mean that there's no new doctor. I mean, if you look at I-40 to Tennessee, there are people leaving the state and there are people coming in. If you just look at one lane, that might give you one impression, but if you looked at both lanes, you'd get a different impression.</p> <p>But the public doesn't want to get into the details of what's going on. They're looking for a villain. So is the press. Things like regulation, reinsurance, profitability--these kinds of questions are not terribly interesting to them. But it really requires knowing that kind of material to understand the insurance industry, and people just aren't willing to invest the time. You talk to Congress, or you talk to the state legislature, and by the time you get there, they are so hyped up, so excited and lobbied that you can't even discuss it in a reasonable way.</p> <p>In the public interest, in the interest of the doctors and the patients, we need to think about a balance. We need to consider the issue from all perspectives.</p> </td> </tr> </tbody> </table> <!-- #EndEditable --></div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-06-01T00:00:00-04:00">Wednesday, June 1, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/may-jun-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">May - Jun 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue <h3 class="field-label"> Cover Story </h3> <h3 class="field-label"> Homepage </h3> Wed, 01 Jun 2005 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500430 at https://alumni.duke.edu https://alumni.duke.edu/magazine/articles/malpractice-insurance-and-feds#comments Lives, Wallet-Sized https://alumni.duke.edu/magazine/articles/lives-wallet-sized <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top"><p class="articletitle">Last January, Mark Pike '04 and Blaise Dipersia '03, friends and former roommates, became co-proprietors of a model 21T color photo booth. The booth is located on the second floor of the Bryan Center, appropriately halfway between a row of vending machines and a film theater. As is required of on-campus vendors, Pike and Dipersia had recently incorporated, and they hoped to kick off the official opening of their new business, Foto Fresh Corp., with a promotional offer: free photos.</p><table width="210" border="0" cellspacing="10" cellpadding="1" align="right"><tbody><tr><td width="190"><div id="album" style="border: 1px solid #CCCCCC; padding: 5px;"><img style="border: 1px solid #333333;" src="/issues/050605/images/photobooth-vid.gif" alt="Video-The Photobooth Project" width="108" height="108" /><img id="lives" style="margin-bottom: 5px;" src="../../images/video.gif" alt="Album" width="150" height="48" border="0" /><div style="padding-left: 5px; font-family: Arial, Helvetica, sans-serif;"><a onclick="popup('http://www.hard-light.com/photobooth/','800');return false" href="http://www.hard-light.com/photobooth/" target="_blank"><strong>The Photobooth Project</strong><br /><span style="color: #333333; font-size: 12px; font-weight: normal;">view now</span></a><div style="padding-top: 8px; font-size: 10px; color: #333333; font-weight: normal; font-style: italic;"><a style="text-decoration: underline;" href="http://www.apple.com/quicktime" target="_blank">Quicktime</a> required, Broadband connection recommended.</div></div></div></td></tr></tbody></table><p>There was just one problem. The booth wasn't working. Things were jamming, screeching, buzzing. A turn of the key, which triggers the photographing process, produced nothing but an out-of-order groan. "It sounds like it's coming from the camera," said Dipersia. "But it could be the engine." He opened a door inside the booth, revealing the "spider": five steel arms designed to clench a strip of film, dip it in a chemical tub, lift, and repeat until the image is developed. "It's like a little dark room in a box," he said admiringly. "But the technology--it's, like, forty years old. It's ancient."</p><p>According to Pike, the idea of putting a photo booth in the Bryan Center came to him during a class with Sam Stephenson, a research associate in the Center for Documentary Studies. The class, "Dream Street: Reading Cities and Towns Today Through Photography," focused on a body of work by the late Life photographer W. Eugene Smith, whose photographs of Pittsburgh in the mid-1950s exposed one of the defining paradoxes of American life: the industrial might of cities and the general impoverishment of the laborers who built them. But it was the work of another pioneering documentarian, the Austrian-born August Sander, that made the biggest impression on Pike.</p><p>"Sander would ride his bicycle around the German countryside--this was in the early 1900s--and he'd set up his equipment for people to make their own portraits," says Pike. "He wanted to create this visual record of German society." Indeed, Sander had big plans. He called his project, which he pursued for more than forty years, until his death in 1964, "People of the Twentieth Century." He envisioned a "physiognomic image of an age."</p><p>"One day we were looking at his photos," says Pike, "and Stephenson said, 'Wouldn't it be cool if someone did something like that on a college campus?' He was talking about our class project. We all had to come up with a novel way of documenting the community. And I thought, maybe I could do that with a photo booth. Blaise and</p><p>I had always talked about getting one. We'd just never had a good reason."</p><p>Pike told Dipersia about the plan. They'd buy the booth, set it up in the middle of campus, and, like Sander, create a sort of "community self-portrait." On one side of the booth, they'd mount a mailbox. Next to the mailbox, they'd leave a stack of questionnaires for people to write down their names and addresses and descriptions corresponding to the pictures they had taken. Pike and Dipersia would make a pickup once a week, scan the photos, archive them online, and then mail them back to the address listed on the questionnaire.</p><p>"But then it occurred to us," says Dipersia. "Where does one get a photo booth? So we looked on eBay." After a couple of weeks, they found a seller: Gary Gulley. He had not one but twelve photo booths for sale. "First, we wanted to find out who this Gary Gulley was. We were like, Who on Earth has a dozen photo booths for sale? Nice thing about eBay, you can find out what people have purchased in the past."</p><p>"Right," says Pike. "So we checked him out: A football. A pair of khakis. All the sequels to Tremors."</p><p>"But not the original," says Dipersia.</p><p>"Right, not the original. And an autographed Evil Knievel bike helmet."</p><p>"So he seemed like a good guy."</p><p>Gulley, it turned out, was a salesman with Photo Me U.S.A., a subsidiary of Photo Me International, the company that patented the four-strip-style upright booth in the 1940s. It now operates more than 30,000 machines in 110 countries. "So we called him up," says Pike, "and a couple of weeks later, Blaise was on a flight down to Dallas."</p><p>Gulley met Dipersia at the airport and drove him to the Photo Me U.S.A. warehouse on the edge of town. Inside were hundreds of photo booths, Dipersia recalls. "All different kinds. I saw one that was a telephone booth flanked on either side by photo booths. It was like a spaceship."</p><p>A mechanic named Ed gave Dipersia his first lesson in maintaining the machine, showing him what to do when the gears jammed or the film got stuck or the pictures came out amiss. Plenty of things could go wrong, Ed warned. And they would. But, of course, that was part of the booth's charm, its antique appeal. "Could be the chemicals are low. Could be the chute isn't lined up with the hair dryer. Could be a million things," says Dipersia. "But it makes that picture you get more special, you know? You get something real. You can hold it. You can put it in your wallet. You can cut it up. One for you, one for your girlfriend, one for grandma!"</p><p>Dipersia made the purchase and had the photo booth shipped to the Bryan Center, where, on a recent Friday, after an hour of tinkering around, he seemed to have fixed the problem. "I think we're back in business," he told Pike. "It's working." They began soliciting passersby. "You wanna free photo?" Dipersia hollered to a group of four women click-clacking their way to a rush meeting. "Um...suuuuure," they said.</p><table width="100%" border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/050605/images/lg_photobo029.jpg" alt="Smile for the birdie: quick shots in the Bryan Center " width="580" height="289" border="1" /><p class="caption-text"><p>Smile for the birdie: quick shots in the Bryan Center. <span class="photocredit">Jon Gardiner.</span></p></p></div></div></div></td></tr></tbody></table><p>"Can we all get in?" Dipersia nodded. They dropped their purses, lifted the curtain, and shuffled in, two in front, two in back.</p><p>"When is it going to go?!"</p><p>"I don't know!"</p><p>"Move your head in!"</p><p>"It's about to take it!"</p><p>"Oh my God!"</p><p>"Oh my God!"</p><p>"Oh my God, it just took it!"</p><p>"Aaaaahhh!"</p><p>Dipersia called out again. "Free photos!" Pike walked down the hall and invited employees from the McDonald's to come by. Soon a crowd had gathered, an assortment of strangers. Out of nowhere, it seemed, a sort of party had emerged. People milled about waiting for their turn in line or for their pictures to develop. Music played on a pair of speakers hooked up to an</p><p>iPod, and hors d'oeuvres, in the form of McDonald's chicken nuggets, made their way around the room. "Can I make a mean face?" asked Aaron Kirschenfeld, a senior. "You can make any kind of face you want," said Dipersia.</p><p>"This is a family tradition. I have a bunch of these of my kids and me on my file cabinet," said Mary Creason, a lecturer in physics. "Dang," she said, looking at the photos she'd just taken. "They gave me bunny ears."</p><p>Wil Weldon '96, an instructor in film and video, was on his way to a film-editing workshop in the basement of the Bryan Center. "I think I may have seen one other photo booth in the entire state," said the Thomasville, North Carolina, native. "It's art in progress. It's staged and it's contrived. But with four photographs, you capture something happening between the first and the last--something totally spontaneous."</p><p>Pike looked on with amusement. He seemed pleased. The booth was working, and not just in the mechanical sense. It was bringing a community together. There had been moments like this before, he said. Like the time seven Turkish students packed in all at once. "That's the record," he said. Or the time President Keohane dropped in for a visit. "We were like, 'You wanna get in?' And she got in!" Or the time Pike left the key in the booth and rushed back to get it at two a.m.</p><p>"I was getting ready for bed. And I remembered I left the key. And I was worried somebody might steal the money inside. So I threw on my clothes and drove to the Bryan Center. I run down the stairs, and, just as I get there, I see these two people getting out of the booth. It's a police officer and a security guard. I'm like, 'Is my key still in there?' They're kind of startled, and the policeman says, 'Uh. Yeah, yeah. We were--I just got a call that somebody left a, uh, a key. We were ... checking it out.' And as they're standing there explaining this, a strip falls out of the machine.</p><p>"In the first picture, they look pretty confused. But after the flash goes off, they realize what they've done. In the second one, they're looking at each other and sort of grinning. And by the fourth picture, they're laughing hysterically. They're both facing the camera--these two strangers--and they're smiling, with their arms over each other's shoulders, and I think they just figured, 'We're stuck in here. We're stuck in this moment.' And they embraced it."</p></td></tr></tbody></table> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-06-01T00:00:00-04:00">Wednesday, June 1, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/dm-main-images/lives1.jpg" width="620" height="325" alt="Photobooth boosters: Lower right corner,Pike, left, and Dipersia" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/may-jun-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">May - Jun 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue<section class="field field-name-field-sub-header field-type-text-long field-label-above view-mode-rss"><h2 class="field-label">Sub-header:&nbsp;</h2><div class="field-items"><div class="field-item even">Self-Portraits of a Community</div></div></section> Wed, 01 Jun 2005 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500469 at https://alumni.duke.edu Getting Their Words' Worth https://alumni.duke.edu/magazine/articles/getting-their-words-worth <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <p> </p><table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top" height="1232"><table border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/050605/images/lg_lang0506.jpg" alt="Listen and repeat: language-lab life" width="580" height="255" border="1" /><p class="caption-text"><p>Listen and repeat: language-lab life.</p><p><span class="photocredit">Les Todd.</span></p></p></div></div></div></td></tr></tbody></table><p class="articletitle">Polish your tones!" Carolyn Lee, professor of Chinese, reminded her class. Usually, it is all Mandarin, all the time, with Lee, but these were beginners, students with zero previous experience, and what Lee was hearing wasn't quite right. Pacing the aisles of Carr 102 on East Campus last semester, she listened as they struggled to make a new sound. "Go deeper on the vocal chord," she said. "Nee joo-ay. Nee joo-ay."</p><p>If you were to take the path of least resistance to fulfilling your graduation requirements--which includes a minimum of three courses in a foreign language--you would probably not sign up for Lee's class, "Chinese 1: Elementary Chinese." To do so, for most native English speakers, is to enter a world of linguistic complexity, a language so overwhelmingly foreign that it merits the Foreign Service Institute's Category IV ("super-hard") classification. Indeed, for the "non-heritage learner," the student whose contact with Chinese culture and language begins and ends with the fortune cookie, few first-time experiences could be as daunting.</p><p>For starters, there are the more than 50,000 characters (although one can get by, it is said, on about 3,000); the 403 possible spoken syllables; and the 1,320 hours of instruction--almost three times that of Spanish--required for the student of "average language aptitude" to reach speaking proficiency, according to the Defense Language Institute, which is run by the U.S. Air Force and claims to be the largest language institution in the world.</p><p>Enrollment in Lee's class has increased every year for the past eight years--a measure, perhaps, of just how large China looms in the eyes of students. "And it's not just more students," says Lee. "It's different students, more dynamic backgrounds. A lot of them are interested in pursuing pure scholarship. But we also have students in public policy, political science, art history, engineering, who want to learn Chinese to use in their careers."</p><p>"I already speak Spanish, so I felt like Chinese would be the next most useful language," says Kyle Nishkian, a sophomore in Lee's class. "It's one of the most widely spoken languages in the world. And, supposedly, China is growing as an economic power."</p><p>"Maybe I'll be a diplomat," says sophomore Cara Petty, "or an ambassador. If I could become fluent--that would be a huge asset for me. But it's a very time-intensive ordeal: class five days a week. I have to endure."</p><p>"I plan on becoming a doctor," says Cyrus Amoozegar, a freshman. "The popular consensus is that in ten years the foreign language to know will be Spanish. But China is industrializing and opening its economy to foreign investors. And I think those doctors who are able to speak Chinese will be sought after."</p><p>In 2003, the Modern Language Association (MLA), a scholarly association with the mission of strengthening the study and teaching of language and literature throughout the world, found that more U.S. college students than ever before (1.4 million) were studying a foreign language, and that American colleges and universities offered a greater variety of language courses than in any of the previous five years. "The tongues of American college students are rolling R's in record numbers," reported The Chronicle of Higher Education. And while Spanish remained the most widely taught language in the land, accounting for 53 percent of total foreign-language enrollment nationwide, the number of students taking Chinese had grown fivefold since 1970.</p><p>"I think many of them take it as a challenge," Lee says of her students. "And I respect them for their determination. I know it's not an easy course." Lee, a linguist who is a native of Taiwan, characterizes her teaching style as "organized, clear, and caring," and says she's rewarded by seeing her students change so much over the semester. "They come to class with no idea about stroke order or tones. And in the end, you see them, and they've found a new part of themselves. They're different people.</p><p>"Learning a language has such an impact. It's intimate. You build up cognitive development from the first day to produce the correct sounds. It's like you're making a new molding for the brain."</p><p>Ellen McLarney, an assistant professor of the practice of Arabic, compares it with going to the gym. "You can train yourself. You can teach your throat and your mouth and your tongue how to articulate the sounds." Like Lee, McLarney has seen enrollment in her class swell in recent years. Her elementary Arabic class doubled in size following the September 11 attacks in New York and Washington. "People always try to connect it to that," she says. "And that was part of it. And, yes, there are definitely people who want to take this class for strategic reasons. But I think it's also that this generation has much more of a global consciousness. They actually know where the Middle East is, whereas, when I went to Brown [in the early Nineties], we didn't even have Arabic."</p><p>Shireen Khoury, a sophomore neuroscience major in McLarney's class and president of the Arab Students Association, is a Palestinian American from West Virginia. "Arabic is just a very expressive and beautiful language," she says. "And it's relevant to my life. The year after I graduate, and before I go to medical school, I'm going to work in a refugee camp in Ramallah, in the West Bank."</p><p>A senior math major from New York, Yousef Mian already knew how to read and pronounce Arabic before taking McLarney's class. Like a lot of Muslims, he says, he was taught at a young age to recite the Quran, the holy book of Islam. "But I didn't actually understand any of it," he says. "It's similar to how Catholics are taught to recite Latin in church and don't necessarily understand it. And also, I felt like it's probably a very important language to learn nowadays--given America's foreign policy."</p><p>Air Force ROTC cadet Joanna Mullen, a junior, had the same thought. She'd heard about the thousands of intelligence documents written in Arabic that were piling up at the State Department because of the shortage of qualified translators. "This will probably ensure me job security for several years," she says. "That's one reason I decided to learn Arabic."</p><p>According to the MLA survey, the number of students taking Arabic nationwide nearly doubled between 1998 and 2003, increasing from 5,505 to 10,596. Still, despite the surge in interest and the energy focused on the Middle East, Arabic remains on the periphery: Less than 1 percent of students taking a foreign language are enrolled in an Arabic course; and, as of 2003, just one in ten colleges and universities (of the 780 the MLA polled) included Arabic in their language offerings.</p><p>"There are socio-economic reasons for Arabic seeming foreign to people," says McLarney. "And I feel like, ideologically, that is where my vocation lies--in battling that perception. Arabic is not something strange. It's accessible. And it opens itself up once you dedicate yourself to knowing it."</p><p>McLarney majored in French at Brown. After graduating, she joined the Peace Corps and taught English in Morocco, where she learned her first words in Arabic. "I loved learning Arabic. It was so fun," she says. "People were so welcoming and encouraging and excited. They'd say, 'Oh, you speak a word of our language! Come to our house! Have tea with us! Live with us forever!'" The experience contrasted with her time in France, she says, when she studied at the Sorbonne. "I knew a lot more French than Arabic. But in France, nobody cared. They were cold, rude, mean, hostile."</p><p>Clare Tufts, professor of French and director of the French Studies Program, has heard it before: Parisians are a bit--prickly. "Well, can you blame them?" she asks. "Paris is the number-one tourist destination in the world. And summer is peak season. So when Parisians meet tourists, they're tired and they're hot and they're not on vacation."</p><p>Tufts is just as quick to defend French itself--"You know, it's spoken in over fifty countries"--although at Duke she needn't make much of an effort. The language of Voltaire and Flaubert, of Amelie and John Kerry, may be struggling to maintain its significance on the world stage. (French has effectively ceded to English its long-recognized role as the language of diplomacy.) But it has suffered no such setback in American higher education. At Duke, even as Chinese and Arabic gain ground, curricular options expand, and Spanish continues to attract the most students, French thrives. Last year, enrollment was its highest (at 418 students) since 1987, the year Tufts arrived.</p><p>"I studied Spanish, Italian, German, Latin, and French, and French was the one I stuck with," Tufts says. "You just fall in love with something and keep doing it, I suppose. Obviously, they would all be helpful. But, I'll tell you," she says, "it's my dream to learn Chinese."</p></td></tr></tbody></table><!-- #EndEditable --> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-06-01T00:00:00-04:00">Wednesday, June 1, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/may-jun-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">May - Jun 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue Wed, 01 Jun 2005 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500452 at https://alumni.duke.edu Rethinking the Rhetoric https://alumni.duke.edu/magazine/articles/rethinking-rhetoric <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <p> </p><table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top" height="901"><table width="219" border="0" cellspacing="10" cellpadding="1" align="center"><tbody><tr><td valign="top"><div class="caption caption-center"><div class="caption-width-container" style="width: 580px;"><div class="caption-inner"><img src="/issues/050605/images/lg_ama29.jpg" alt="Sarah Zaman '05" width="580" height="257" usemap="#Map" border="1" /><p class="caption-text"><p><span style="text-align: -webkit-center;">Photo: Les Todd.</span></p></p></div></div></div></td></tr></tbody></table><p class="articletitle">Pro-choice? Yes. Pro-abortion? Not really," wrote Sarah Zaman on the opinion page of The Kansas City Star last February. "This isn't just a question of terminology--this is how some college kids feel.... We call ourselves 'pro-choice,' but our views are grayer than the label suggests."</p><p>Indeed, for Zaman, a senior, it is the labels, not the concepts, that have set the parameters for the current debate over abortion and left little room for the nuanced views of a new generation. "I was a lot more middle-ground than I thought," she says. "And I can't speak for everyone, but I think a lot of college kids are tired of the either-or rhetoric. It doesn't allow for meaningful discussion. We always hear about [abortion] in terms of black and white. And in class I was finding this gray area."</p><p>The class was Professor Kathy Rudy's "Genetic and Reproductive Ethics," which Zaman took fall semester. It examines the frontiers of genetic manipulation and reproductive therapies, and takes on the ethical questions surrounding surrogate motherhood, abortion, and cloning. One day, Zaman recalls, Rudy conducted a class exercise in which she acted the part of an old pro-life friend. "We had to explain and defend our pro-choice stance to her. We had to figure out how to have that discussion without reaching dead ends, and that meant acknowledging our own uncertainties."</p><p>After the class ended, Zaman says, Rudy urged her to keep going, "to take what I was saying in class and do something with it. She said, 'Write an op-ed and send it out to papers.' So, I did. I went home over Christmas break and wrote it, and I sent it to the Duke News Service and asked them to send it to papers."</p><p>It was the sort of nudge Rudy, a two-time Distinguished Teaching Award winner, is well known for giving. "I want them to know the theories involved in the issue," she told Duke Dialogue in 2000 after winning her second award. "But I don't want them to deal with the issues abstractly."</p><p>In the weeks after Zaman's op-ed ran in The Kansas City Star, Raleigh's News & Observer, and The Dallas Morning News, e-mail messages flooded in--"from abortion-clinic nurses, Republican parliamentarians, professors, veterans of the Roe v. Wade rallies, grandmothers in their eighties," she says. "I managed to infuriate both sides. But some people told me I'd actually articulated things they'd been feeling for a long time."</p><p>Zaman, who'd never before written for publication, says the experience was revelatory in a way nothing in her college career had ever been. For all of her activities--she is pre-med, plays violin in the Duke Symphony Orchestra, and volunteers in Duke's chapter of the Red Cross--this was the first time she'd taken something from the classroom directly into the world, in effect exporting a campus dialogue far beyond the campus borders.</p><p>"It's pretty difficult," she says. "You have to distill your argument to a single page. But it's very gratifying, too. All of a sudden, it works. You're having an impact. You're having conversations with people you'd never have talked to otherwise. It makes me want to try it again. There are so many issues I could tackle--Social Security, prenatal drug abuse, euthanasia.... Who knows?"</p></td></tr></tbody></table><!-- #EndEditable --> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-06-01T00:00:00-04:00">Wednesday, June 1, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/may-jun-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">May - Jun 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue<section class="field field-name-field-sub-header field-type-text-long field-label-above view-mode-rss"><h2 class="field-label">Sub-header:&nbsp;</h2><div class="field-items"><div class="field-item even">Sarah Zaman &#039;05</div></div></section> Wed, 01 Jun 2005 08:00:00 +0000 Joseph Sorensen, JOSEPH E. 18500429 at https://alumni.duke.edu Really Big Business https://alumni.duke.edu/magazine/articles/really-big-business <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <table border="0" cellpadding="2" cellspacing="0" style="width:98%"> <tbody> <tr> <td> <table align="right" border="0" cellpadding="1" cellspacing="10" style="width:224px"> <tbody> <tr> <td> <div class="caption caption-center"> <div class="caption-width-container" style="width: 200px;"> <div class="caption-inner"><img alt="Gereffi: " src="/issues/030405/images/lg_gere27471.jpg" /> <p>&nbsp;</p> <p>Gereffi: "Wal-Mart has taken giantism to a new level"</p> <p>Photo:Jim Wallace</p> <p>&nbsp;</p> </div> </div> </div> </td> </tr> </tbody> </table> <p><strong>With the start of 2005 and the phasing-out of decades-old quotas, the landscape of global commerce is set to change in dramatic fashion. China is poised to dominate manufacturing, India to absorb more white-collar jobs, and Wal-Mart to continue unbridled as the king of retail. </strong></p> <p><strong>Gary Gereffi, professor of sociology, talks about how it all happened, and what it all might mean.</strong></p> <p><strong>When did global outsourcing begin?</strong></p> <p>We began to see it in the 1960s with U.S. offshore-assembly programs in Mexico, the so-called "twin-plant programs." A company making transistor radios or auto parts would send parts to an export-processing zone somewhere in Mexico, have the parts assembled by cheaper labor, and then re-exported back into the U.S. as a completed product.</p> <p>The idea was that U.S. firms could keep their high, value-added core competencies of design and marketing, and they could send the production abroad where labor was cheaper. And we've been in this outsourcing mode for so long now that we've assumed we don't need production anymore. But these other countries that have the manufacturing base are beginning to reintegrate. Our companies are downsizing. Well, if you do the manufacturing and you develop a design capability to create new products and you can brand them, then you've got the whole package. You're in a much tougher competitive position in many ways than the U.S. companies that still need to look for somebody to make their products.</p> <p><strong>What's the U.S. reaction to this new competition?</strong></p> <p>One standard reaction is protectionism: Keep foreign products out of the U.S. economy. But that flies in the face of the fact that ever since the 1950s and the end of World War II, the U.S., as the predominant postwar power, has favored an open economy. We've wanted our markets open to direct foreign investment, and we've wanted to have countries recognize intellectual property rights, because we've assumed, rightly for the most part, that as the strongest economy in the world, we gain more from open international economic conditions than our rivals do. So, generally speaking, the U.S. has been the champion of a free-trade economy.</p> <p><strong>What about NAFTA? Is that promoting free trade?</strong></p> <p>It's not. Free trade is just a theoretical ideal. Most of the trade agreements are conditional. And we have lots of regional trade agreements. But the fact that the U.S. passes NAFTA and adds Mexico and Canada to the U.S. as a big regional economy doesn't mean that internationally, through the W.T.O. [World Trade Organization], we weren't also favoring global trade openness.</p> <p><strong>What would Adam Smith say about this?</strong></p> <p>I'm not sure that Adam Smith's own work got into all of the political complexities of making these things work. That's a commonly mistaken assumption; we somehow think that free trade means that governments don't play a role. In fact, we need very sophisticated political institutions to provide some kind of infrastructure for these economic exchanges to work.</p> <p><strong>The quota system is part of this infrastructure?</strong></p> <p>Yes, the quota system allowed us to do two things: It placed a ceiling on some of the countries that we thought were the most powerful exporters. But it also gave a share of the U.S. market to everybody. And that philosophy dates back to the 1960s. The U.S. said, We don't want countries to be continually reliant on us for foreign economic aid. We prefer to promote private enterprise, and we encourage them to export into the global economy. That's been the mantra of the World Bank since the mid-1980s, also called "neoliberalism," also called "the Washington Consensus." I think all of the U.S. administrations have been in favor of trying to keep the playing field level--with a few big exceptions.</p> <p><strong>Like what?</strong></p> <p>Agriculture has been a big exception. Developed countries have basically continued to subsidize our farmers in ways that make it much harder for developing countries to export agricultural products to the United States. And it makes it a lot easier for us to export our agricultural products to them at lower prices that they can't match.</p> <p><strong>And the big winner is Wal-Mart?</strong></p> <p>Wal-Mart has taken giantism to a new level. It's the largest employer after the federal government and the main channel for imports into the U.S. market. And it's an incredibly important force in maintaining free trade because it will challenge manufacturers if they try to impose any restriction on imports or exports.</p> <p>But with Wal-Mart, we've moved far away from the "Ford model." Henry Ford wanted to pay his workers enough that they could afford the products they were making. Now people say, sort of tongue in cheek, Wal-Mart is paying its workers so little that they have to go to Wal-Mart to shop. So, where government has to step in is where you have this huge loss of manufacturing jobs. We have to find some way to make sure that globalization doesn't mean an erosion of our productive base. We have to somehow keep building our workforce up, and I think a key to it has been educational institutions where we have been a world leader. But we can't rely on that indefinitely without countering some of the restrictions on immigration.</p> <p>So, when you look at a phenomenon like Wal-Mart, Wal-Mart has helped keep the U.S. inflation rate down three or four percentage points over the last decade by bringing in the lowest-cost products and forcing lots of other suppliers to meet these low prices. I think now what people are starting to worry about is the fact that it's not just these blue-collar jobs that are moving offshore but it's also professional jobs like the ones in the information-technology industry, and so you start getting new competitors like India.</p> <p><strong>Why India?</strong></p> <p>Supposedly, India's edge in some of this programming started with the Y2K problem. The U.S. was concerned that we didn't have enough programmers to rewrite all of this code, so we created a new category of visas that allowed lots of programmers from India to work here. From about 2000 to the present, India has gotten more and more involved in supplying information-tech services that U.S. companies need. Now they've set up companies in India, like Wipro and Infosys, that are saying, Look, we can take advantage of the fact that we're about twelve hours ahead of the U.S. We could have a twenty-four-hour work cycle. We get U.S. companies to shift some of the more routine activities here. But what's happening is their own wage rates are going up. Cheaper countries are going to come online. And India is going to have to do some of its own outsourcing. It's just a perpetual-motion machine.</p> <p><strong>Is the U.S. in trouble?</strong></p> <p>I think we could be. We're still ahead of the game. But all of the long-term trends are favoring other countries that are investing much more heavily in their infrastructure. And if you talk to people in industry after industry in the U.S., we're losing skills. I think we really do run this risk of relying so heavily on other countries that, without incredible innovation, there's going to be a real shift in global bargaining power.</p> </td> </tr> </tbody> </table> <!-- #EndEditable --></div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-03-31T00:00:00-05:00">Thursday, March 31, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/mar-apr-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Mar - Apr 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue <h3 class="field-label"> Cover Story </h3> <h3 class="field-label"> Homepage </h3> Thu, 31 Mar 2005 10:00:00 +0000 Joseph Sorensen, JOSEPH E. 18501261 at https://alumni.duke.edu https://alumni.duke.edu/magazine/articles/really-big-business#comments Addressing the Stressing https://alumni.duke.edu/magazine/articles/addressing-stressing <div class="field field-name-body field-type-text-with-summary field-label-hidden view-mode-rss"><div class="field-items"><div class="field-item even" property="content:encoded"> <p> </p><table width="98%" border="0" cellspacing="0" cellpadding="2"><tbody><tr><td valign="top" height="1232"><table width="30%" border="0" cellspacing="10" cellpadding="1" align="right"><tbody><tr><td align="center"><div class="caption caption-center"><div class="caption-width-container" style="width: 234px;"><div class="caption-inner"><img src="/issues/030405/images/lg_massage115542.jpg" alt="Kneading relief: senior Nicole Ambrosetti gets a massage from senior Brad Labez-Tapang " width="234" height="350" border="1" /><p class="caption-text">Kneading relief: senior Nicole Ambrosetti gets a massage from senior Brad Labez-Tapang <span class="photocredit">Photo: Chris Hildreth</span></p></div></div></div><p> </p></td></tr></tbody></table><p class="articletitle">Will Cooper III, a sophomore biomechanical engineering major and member of Duke Student Government (DSG), was the picture of relaxation one balmy evening in early December, which, by the curricular calendar, was no time to be relaxing.</p><p>It was exam week, and, in typical fashion, all extraneous doings had come to a halt: no practices, no classes, no parties. Across West Campus, traffic had thinned, the quads had quieted, and the library, like the lone hotel in a blizzard, was filled to capacity.</p><p>Rather than snow, it was stress that descended on the campus, spreading like an odorless toxin, sapping energy and slowing strides and muffling the sounds of student life in an atmosphere of collective pressure.</p><p>There was, however, one space that remained untouched, one pocket of peace and tranquility. And Cooper was sitting in it. Munching on a powdered-sugar brownie, he pondered aloud trivia from a board game in Meeting Room B of the Bryan Center, site of the first DSG-sponsored "Stress Free Zone":</p><p>"The leaded nozzle has to be thicker than the unleaded. Right? 'Cause leaded gas is really bad for your car."</p><p>"Henry VIII beheaded how many of his wives? Anybody?... Two. Anne Boleyn and Catherine Howard."</p><p>The Stress Free Zone, according to Cooper, who was in charge of maintaining its state of calm, was conceived as a refuge for the exam-weary, an enclave of effortlessness and entertainment for the overanxious and under-rested. Outside the Zone were expectations and an endless supply of caffeine to meet them. Inside were decks of cards, Chevy Chase movies, lemon bars, Swiss Miss, and two graduates of "Physical Education 119: Massage Therapy," who provided their services free of charge. "We just wanted to make an atmosphere where people could come in and decompress for awhile," said Cooper. "The intensity in the reading rooms [in Perkins Library] is just ridiculous right now. If you breathe too loudly, people get upset."</p><p>Others in the Zone agreed. It was too much. They'd been shushed, given the fish-eye, asked to leave. "This guy totally chewed me out for whispering. Just whispering!" said Katherine Robinson, a senior, as she slurped a bowl of mandarin soup. And they'd escaped to the Stress Free Zone to rest their brains and replenish their energy, they said, before heading out to brave a long night in the stacks or a research paper in the computer cluster.</p><p>"I've got one day to write twenty pages on zebra fish regeneration," said Maureen Murphy-Ryan, a sophomore biology major, as she watched Christmas Vacation on a tinsel-covered TV. Would she finish in time? "You'd be amazed what you can do in twenty-four hours." Still, Murphy-Ryan was being careful to budget her time for enough sleep. "There was a girl in my dorm freshman year who was so stressed out," she recalled. "She pulled an all-nighter for an exam at 9:00 the next morning. But she tried to take a little nap and woke up at 10:00. She was hys-ter-i-cal. She ran across campus, ran into the classroom, and vomited! In front of everyone! I felt so bad for her."</p><p>Stories of all-night cram sessions and test-taking catastrophe are hardly new to the college landscape. But over the last decade, as colleges have become more mindful of the mental-health issues affecting a new generation of students, the old stories have gained a new relevance. In the hopes of averting such disasters, a number of colleges have begun extending a therapeutic hand to those students enduring what have long been considered the ordinary strains of academic life. Now available during finals at many schools, public and private, are free massages, soothing music, sweets and tea--even canines to cuddle.</p><p>As Kevin Kruger, associate executive director for the National Association of Student Personnel Administrators, told The New York Times last April, "This movement is an indication of colleges trying to be more proactive, rather than waiting for students to flunk out, have a breakdown, or whatever the outcome is going to be." Duke is no exception. "We've been paying more attention to this lately," says Ryan Lombardi, assistant dean of students. "Research and anecdotal evidence suggests that students are arriving on campus with increasingly complex mental health issues. So there are pre-existing medications and conditions to be aware of."</p><p>"Academic stress is probably the most common reason students come in to see us," says John Barrow, assistant director of Counseling and Psychological Services (CAPS) at Duke and an assistant clinical professor in the division of medical psychology. Barrow says students do not tend to identify grades as the source of their stress, but that anxiety lurks under the surface, hidden among other stressors--typically relationships--and compounding them. In the weeks leading up to exams, says Barrow, "we prescribe mostly short-range tactics for stress management. This isn't the time when they're going to start making the fundamental changes, the behavioral changes, and the values assessments that could reduce stress in their lives. But we encourage them to be realistic about how much they can do in a day and to recognize that they'll need to rest at times, to let the biological system come down from peak intensity." A stress-free zone? "That's great," he says. "It sends the message that taking a break is okay; it's institutionally sanctioned."</p><p>Back in the Stress Free Zone, Cooper reinforced that message: "There's no stressing in here," he announced to the room. "That's the only rule." A line had formed for free massages. Old School played on the TV. And Cooper quizzed the crowd with questions of no significance to an academic record: "What kind of nut is used in marzipan?" he asked. "What is marzipan?"</p></td></tr></tbody></table><!-- #EndEditable --> </div></div></div> <h3 class="field-label"> Published </h3> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2005-03-31T00:00:00-05:00">Thursday, March 31, 2005</span><section class="field field-name-field-main-image field-type-image field-label-above view-mode-rss"><h2 class="field-label">Main image:&nbsp;</h2><div class="field-items"><figure class="clearfix field-item even"><img typeof="foaf:Image" class="image-style-none" src="https://alumni.duke.edu/sites/default/files/default_images/dukmag-horizontal-placeholder.jpg" width="238" height="140" alt="" /></figure></div></section><section class="field field-name-field-author field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Writer:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/author/patrick-adams" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Patrick Adams</a></li></ul></section><section class="field field-name-field-issue field-type-taxonomy-term-reference field-label-above view-mode-rss"><h2 class="field-label">Issue:&nbsp;</h2><ul class="field-items"><li class="field-item even"><a href="/magazine/issue/mar-apr-2005" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Mar - Apr 2005</a></li></ul></section> <h3 class="field-label"> Featured article </h3> No <h3 class="field-label"> Background color </h3> blue Thu, 31 Mar 2005 10:00:00 +0000 Joseph Sorensen, JOSEPH E. 18501282 at https://alumni.duke.edu