The 6-year-old boy’s BMI was in the 98th percentile. He was an active kid, but he loved processed food and was at risk for constipation, chronic abdominal pain, and attention issues.
His parents looked for help. They went to Yum Pediatrics in Spotsylvania, Va.—the office of Nimali Fernando (MPH ’98, MD ’99). Yum Pediatrics has an in-office test kitchen, where Fernando and health coaches offer cooking classes. The couple signed up for the Parenting for Wellness Seminar, an eight-meeting series that teaches parents how to raise healthy, adventurous eaters. “After a couple of months, I saw his body mass index plummet into the normal curve,” Fernando says of the boy. “He had a calmness about him, and it was probably because he was actually eating real food.”
Fernando—known as Dr. Yum around her community—also helps families learn about nutrition through her nonprofit organization, the Doctor Yum Project, which she started with her husband, Daryle Darden (MD ’99). At Fernando’s office, patients can learn how to cook a bean burger from the waiting room’s TV or grab fresh vegetables from the garden outside. “What I found in my career is that so much of the symptomatology that we see can have a direct correlation to food,” Fernando says.
In October, Fernando’s guide, Raising a Healthy, Happy Eater, was published. Coauthored with feeding specialist Melanie Potock, the book features recipes and parenting tips; it also showcases what kids around the world eat, from crepes to kimchi. Fernando’s own children have “food passports” where they keep track of their culinary adventures—with souvenirs like a message in Amharic from an Ethiopian restaurant.
“Be joyful about mealtimes and eating,” Fernando says of the book’s core message. “We want parents really to be able to not focus on food going into the mouth, but the experience of being at the table as a family.”
Photo courtesy Daryle Darden
David Shulkin: Unusual Residency, Presidential Appointment
BY NICK KEPPLER
General medicine residents spend their days seeing patients, mastering clinical skills, absorbing a ton of information, and developing a bedside manner. When David Shulkin (Res ’89, Fel ’90) trained at Pitt, he also spent a lot of time going through stacks of file folders.
Shulkin, who had followed his wife-to-be, Merle Bari (Res ’90), to Pitt, where she pursued her dermatology residency, asked his advisors to allow him to study care costs at insurer Blue Cross of Western Pennsylvania. It was the first time a resident had made such a request, Shulkin recalls. “They were amazingly open to allowing me to explore my interests and my desire to understand how [the business of ] health care works.”
Shulkin would go on to manage huge health care systems, including one of the nation’s largest: the U.S. Department of Veterans Affairs.
That early Pittsburgh study on health care costs was so fascinating and promising, Shulkin stayed on an extra year as a general medicine fellow to complete the project.
His findings, published in the Annals of Internal Medicine and covered on the front page of the Pittsburgh Post-Gazette, showed that doctors largely had no knowledge of the cost of the care they provided. This was leading to the rise of a managed care industry to keep costs in check—yet the increase in administrative costs was also raising the price of health care. “We were at the beginning of a trend showing health care costs were set to explode,” he recalls, “and as we now know, that’s become a fundamental issue in health care design.”
Shulkin would later spend four years as president and CEO of New York’s Beth Israel Medical Center and serve as the president of the New Jersey–based Morristown Medical Center. He also founded DoctorQuality, an early informational Web site for health care consumers.
In 2015, Shulkin became the VA’s under secretary for health. (President Obama nominated him in March, and the Senate confirmed him in June.) The VA is a behemoth of a health care system: Its annual budget is $59 billion; the system employs 300,000 people; and it stretches across more than 1,500 facilities. As if that isn’t enough of a challenge, Shulkin is taking the helm at one of the most difficult times in the department’s history. In June 2014, 35 veterans died waiting for care from the VA system of Phoenix. Subsequent investigations by several government agencies showed the system was buckling under increased demand for care. Nationwide, about 57,000 patients were waiting for appointments, and VA facilities had kept secret waiting lists and falsified data. The scandal led to the resignation of Secretary of Veterans Affairs Eric Shinseki and the early retirement of Shulkin’s predecessor, Robert Petzel.
As part of the VA’s new leadership, Shulkin says he is walking a balance between implementing reforms and helping VA employees keep their chins up in light of a difficult job and public scrutiny. “The morale at the VA today is not where it needs to be,” he says. “It’s demoralizing to work as hard as I know our employees work and not be recognized for that work.”
He says his other key goals are ensuring that every veteran who needs immediate care gets it and that others are seen within 30 days or are given the option to see a privatesector provider. (The latter is an option provided by the Veterans Access, Choice and Accountability Act of 2014.)
Shulkin still credits that unusual residency rotation at Pitt and the advisors who signed off on it with his position in the VA.
“If it wasn’t for the experience they allowed me to have, to be different from the typical resident, I’m not sure I would be where I am today.”
Photography by Mike Drazdzinski/CIDDE