On the first floor of the UPMC Eye and Ear Institute, a clinician tests a new surgical robot with a flexible arm. The device was developed at Carnegie Mellon University, tweaked at Pitt Med, sold by a private company in Boston, and has found its way back to Pittsburgh, where surgeons are now using the robot for transoral and colorectal surgery. How did engineers, clinicians, and entrepreneurs find their way into the same room? They collaborate at Pittsburgh CREATES, Pitt Med’s new lab where clinicians and engineers work side by side to build and evolve surgical technologies.
“What we’re there for is to bring thought leaders together with clinicians who probably have the greatest insight into how to improve the outcomes for patients,” says Max Fedor, executive director of Pittsburgh CREATES. The lab was developed by Fedor, Umamaheswar Duvvuri, assistant professor of otolaryngology, Carl Snyderman, professor of otolaryngology and neurological surgery, and Jonas Johnson, chair of otolaryngology. It differs from other innovation labs around the country in that it operates on a fee-for-service model; surgeons work on single assignments rather than large research projects. “When we need to bring in clinicians, they’re nearby. They can come in for an hour; they can work with us; they can go back to the OR,” says Fedor.
Overheard: Culture Shock
BY KATY RANK LEV
How do you say “contractions” in Uzbek? Daniel Lattanzi (Res ’82), assistant professor of obstetrics, gynecology, and reproductive sciences, works with video translators regularly at UPMC Magee-Womens Hospital. He sees an increasing number of patients from North and Central Asia. But he’s finding that communication challenges span more than just vocabulary. For example, Lattanzi learned that in Uzbek culture, women aim for four children. “That’s good for business,” he says with a laugh. It also emphasizes how much he and his residents have to learn about his patients’ various cultures, particularly how those cultures conceptualize motherhood and pregnancy issues.
How do cultures around the world view postpartum depression differently than we do in the United States?
Many cultures do not accept depression as a problem that can be treated and addressed. There are cultural issues related to how you are supposed to behave and feel after having a baby, and there can be stigma or repercussions for the entire family if a woman deviates from these norms. We have to accept the fact that, in other cultures, women have different roles. That’s not right or wrong. A lot begins with understanding the cultures we are interacting with and being supportive rather than making everyone American. Many of our patients are separated from family, which puts them at an increased risk for postpartum depression. So many other countries have wonderful systems to take care of women after childbirth, with relatives coming in to take care of the home and other children and the mother herself. Here, there’s nobody to help.
How have you adjusted your standard postpartum depression screening tools to better serve this foreign patient population?
Written screening forms are often easier for women to fill out because they feel like they have some privacy, but I will often see women just randomly circling answers because they don’t understand the questions. Not only is the concept or perception of depression different in some cultures, but concepts like “sometimes” versus “often” are difficult to grasp. Our forms need to make sense culturally. We collaborate with our social work staff to gather these patients’ histories and provide the total care they need.
Has this awareness changed your practice model?
We are trying to establish a specialty subclinic where patients with limited English proficiency can come and be treated in a culturally comfortable way. Our immigrant patients have the same interests and needs as all women. They want a relationship. Someone they can trust. We want to create that environment for them. It starts with good communication. A dream of mine is that everyone will consider that not all patients have the same background and see this as an important part of providing care.
It’s a Rocky-esque story in the world of medicine—that’s how Carl Kurlander, a film studies senior lecturer at Pitt, describes Burden of Genius: Dr. Thomas Starzl’s Journey into Organ Transplantation, a documentary he coproduced with Laura Davis about the legendary Pitt Med surgeon. Burden of Genius chronicles the medical and professional challenges Starzl overcame to give hope to patients with liver failure. Starzl, an MD/PhD who died in 2017, performed the world’s first successful liver transplant in 1967 at the University of Colorado.
The film, directed by Tjardus Greidanus, won the Cleveland International Film Festival’s Global Health Competition prize in April. The heart of the documentary, says Kurlander, is Starzl’s unrelenting belief in science’s ability to heal. He adds, “If [Burden of Genius] was just a movie about a brilliant, innovative surgeon . . . that would have been enough. But in watching this film you realize that it was all driven by a man who had a vision, and he would not be stopped, which is what made him one of the greatest medical figures of the 20th century.”
Starzl, who joined Pitt in 1981, also is credited with developing the organ procurement and immunosuppressant protocols necessary for successful transplants. Early in his career, the surgeon acquired many detractors who believed that transplantation was ethically unwise. In fact, it was when one of Kurlander’s Pitt film students showed him a 1983 clip of Nightline, during which Ted Koppel asked Starzl if he was giving people false hope, that Kurlander realized the narrative potential of Starzl’s story.
See the film trailer here.
Sound Check
BY ELLEN KRUCZEK
How can one of the smallest communication systems be studied? A prototype developed in a Duke/Pitt/Carnegie Mellon/MIT collaboration probes what’s happening in the fetus. The method uses acoustics to isolate exosomes, extracellular vesicles used in cell communication. With the new technique, separation takes less than an hour and lessens sample damage compared to the standard method. Pitt’s Yoel Sadovsky, executive director of Magee-Womens Research Institute and Elsie Hilliard Hillman Professor of Women’s Health Research, was a coauthor of the resulting publication in PNAS. Sadovsky imagines one day using the approach for determining the health of placentas through their exosomes, which circulate in the mother’s blood during pregnancy.
Footnote
George Harrison—the quiet genius of the Beatles—helped popularize Indian music in America in the 1960s. Vijay Bahl, codirector of Pitt Med’s endocrine fellowship training program, has been championing the genre for local fans for more than 40 years. Bahl (Res ’74, Fel ’77) cohosts Music from India at 8 p.m. on Sundays on 90.5 WESA with Harish Saluja, who started the show five years before the Pitt Med doc joined. Music from India is the longest-running Indian music program in the country, and it features the genre in all its forms, from classical to modern.
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Cami Mesa photographed Daniel Lattanzi for Overheard.
Pittsburgh Post-Gazette photographer John Kaplan took the picture of Thomas Starzl and Oscar Bronsther as they got off a plane.
The final image, “Isolation of exosomes from whole blood by integrating acoustics and microfluidics” by Mengxi Wu et al, is licensed under CC by NC-ND 4.0.
