Class Acts, Fall 2015

Joy Ruff: From Iraq with Love
Fall 2015

"When you’re in a situation where you’re being told to leave, you don’t think about what to pack,” says Joy Ruff (MD ’12). “You just run.” 

Ruff recently returned from a 10-day trip to Northern Iraq where she and other physicians treated refugees fleeing the Islamic State–controlled areas of Syria. 

Ruff tries on a Kurdish style hat at a market in Iraq.

The doctors set up makeshift care facilities in abandoned warehouses and treated upwards of 100 patients a day. In many cases, the refugees they met had to evacuate their homes within minutes, meaning they arrived in Iraq with no possessions—including vital medicines.

Although Ruff is a family practice physician, she says much of what she did in Iraq was triage—administering stitches, checking vitals, and supplying prescriptions. But according to Ruff, the most important thing she did was listen.

“Just sitting down and talking to these people, hearing their stories, hearing their frustration—it was heartbreaking,” says Ruff. “Most of the time I felt like what they needed was someone to give them an ear, someone to help them process the grief and trauma.”

Ruff’s trip was part of a holistic family medical residency program called In His Image, which is based in Tulsa, Okla., at St. John Medical Center. Disaster relief is part of its outreach curriculum.

As the mother of three children— Nathan (7), Zach (5), and Grace (1)—Ruff said it was difficult to hear stories of families being forced out of their homes. She cared for engineers, pharmacists, and bakers—normal people living normal lives until the moment ISIS started firing bullets at them.

She thinks the time she spent in Iraq will make her a better family doctor down the line.

“When you see people suffering on a large scale like that, it keeps you soft and reminds you why you’re doing it,” says Ruff, who is a fellow at the University of Alabama.

“It gets you away from the bureaucracy and paperwork and other issues we sometimes have to deal with. Just seeing those people and feeling their need, offering your skills and your care and your love.

“That’s actually the heart of medicine.”


Richard Pan Pursues Community Immunity


Pan speaks at a hearing of the California Senate Health Committee for his legislation SB 277, which has toughened vaccination requirements for California schoolchildren. (Photo: Lorie Shelley)


In the past three years, the Golden State has done an about-face. Back in 2010, California claimed some of the most lax childhood vaccination requirements in the nation; today, it has some of the toughest.

Credit the state’s senator from Sacramento, Richard Pan (MD ’91). Signed into law by Governor Jerry Brown in July, Pan’s SB 277 legislation eliminates California’s personal belief and religious exemptions. Beginning in July 2016, only children up-to-date on all state-mandated vaccinations—or those with a note from a physician noting that immunization is not safe for them—will be allowed to enroll in public or private schools. “This is the first time that a state has rolled back all of [its] exemptions,” says Pan. “I’m hoping others will follow our lead.”

Pan coauthored the bill with state Senator Ben Allen as last winter’s measles outbreak— originating at California’s Disneyland—turned local vaccination rates into a national story. “Looking at the data, those of us in the public health realm had recognized we were vulnerable,” says Pan. “That became a real-life danger as measles spread across the state.”

And yet, the legislative move has been far from universally popular. After a series of threats against Pan, capitol security guards began accompanying him to hearings and votes on the bill. Within days of the governor’s signature, activists launched recall efforts aimed both at the senator’s seat and the legislation itself. (They failed to get enough signatures.)

SB 277 was Pan’s second foray into the world of vaccine legislation. As a state assemblyman— the first MD elected to California’s Democratic Caucus and the first pediatrician elected to the state’s legislature—he authored AB 2109, mandating a health care provider’s signature on exemption forms. “That law reduced the personal belief exemption [use] by 20 percent,” says the senator. “Once they had to go to the doctor to get the exemption, many just got the vaccination instead.”

Pan, who turned 50 this fall, was born two years after the measles vaccine was released. Vaccinations for pertussis and polio—the latter developed, of course, by a team led by Jonas Salk, an MD, during his tenure as director of Pitt’s Virus Research Laboratory—were already commonplace. By the time Pan started kindergarten, vaccines were also available for mumps and rubella. When the aspiring physician arrived at Pitt in the 1980s, vaccines were so broadly deployed, faculty couldn’t imagine a resurgence of preventable childhood illnesses. In his microbiology course, recalls Pan, the textbook featured photos of a measles rash, but the professor— Julius Youngner, an ScD virologist instrumental in developing the polio vaccine, who’s now Distinguished Service Professor Emeritus in Pitt’s Department of Microbiology and Molecular Genetics—assured his students that, like polio, measles had been all but eradicated. “We were taught that unless we went on a mission outside the country,” Pan says, “we weren’t going to see some of these diseases.”

And yet in his fourth year of medical school, as a trainee with the U.S. Public Health Service, Pan came face-to-face with measles. It was January 1991, and Philadelphia was in the grips of an epidemic that originated in two religious communities whose members refused both vaccines and medical care. Throughout the course of six months, more than 1,000 people were infected and nine children died.

“It was horrible,” says Pan.

To make his case with fellow legislators this summer, Pan used FRED (Framework for Reconstructing Epidemiological Dynamics), a computational modeling tool from Pitt’s Graduate School of Public Health that simulates disease outbreaks and allows users to compare the potential severity of an outbreak depending on whether a city has an 80 percent vaccination rate versus a 95 percent vaccination rate. “I’d pull up a colleague’s city and say, Here’s what will happen in your city, in your county. Watch the dots,” says Pan.

“It was a great way to illustrate at a very direct level what would happen if we didn’t get our immunization rates up.”