SANDRA R. HERNÁNDEZ, M84, on being a physician with a public health mission
During my residency in one of the epicenters of the HIV crisis—San Francisco General Hospital—I began to understand the interface between health care and the social factors that affect health. When I was approached about joining the AIDS Office at the San Francisco Department of Public Health, I jumped at the chance. The people there worked with urgency: seven days a week, all through the night. Public health is a team endeavor, and we had an entire community coming together to address HIV. At the same time, I continued to do clinical work, because my patients kept me grounded and because I felt it would help me make better policy. I once had an HIV patient who identified as a bisexual male. He was living in a garage because his family was afraid for him to touch anything. His experience profoundly informed my work when my department took on housing policies for people with HIV. The health challenges are different today, but many of the lessons we learned endure. Like HIV did, the opioid epidemic is forcing us to address substance abuse, behavioral health, and physical health in an integrated way, ensuring that what we do in health care matches what is needed in the real world. —As told to Molly McDonough
Hernández is president and CEO of the California Health Care Foundation.
TE-WEN CHANG, M84P, on solving the mystery behind deadly colitis
When humans take antibiotics, they develop diarrhea, and some develop a more severe form—colitis. No one knew why.
In 1977, my colleague John Bartlett began to study antibiotic-associated diarrhea in animals. After feeding the antibiotic clindamycin to hamsters, the animals developed severe diarrhea and eventually died. I became interested in his data at a research conference and asked him to give me a small stool sample for my tissue culture study. After inoculating the tissue culture, I found that the hamster stool specimens caused damage to the tissue culture cells. I kept asking myself, What could be doing the damage? A virus was ruled out because the agent could not be propagated to fresh tissue cultures. If it’s a bacterial toxin, what kind of bacteria is it? After extensive testing, I learned the bacterial strain responsible was Clostridium difficile, or “C. diff.” It was the first time C. diff toxin was isolated.
Around that time, an article appeared in the British Medical Journal describing an unknown bacterial toxin from patients with antibiotic-associated diarrhea. I sent a piece of filter paper coated with antitoxin to the author, and within a week the report came back positive for C. diff toxin. This was the first time C. diff toxin was detected in humans with antibiotic-associated diarrhea. In other words, I had found the cause of this disease in humans.
Since we did not have any data to prove the British study, Marc Gurwith collected stool samples from his patients at the Boston VA hospital, and Bartlett transferred them to Tufts New England Medical Center, where I carried out the toxin studies. Bartlett wrote the paper, published in the New England Journal of Medicine in 1978. After that, we were able to use Clostridia antitoxin to make a diagnosis of C. diff disease, because of a hidden C. diff antitoxin I detected in Clostridia and sordellii antitoxins. We performed more than 800 tests for physicians across the U.S., with specimens arriving from every state. Before, we didn’t know what caused this potentially life-threatening disease in humans. Now we knew. —As told to Francis Storrs
Chang, an associate professor emeritus of public health and community medicine, received a Dean’s Medal in 2015.
NAHID BHADELIA, J99, F04, M05, on fighting Ebola
I didn’t realize how dire the Ebola epidemic was in West Africa until I landed there in 2014. It ravaged communities, and many of my colleagues became ill or passed away. Most people believe they wouldn’t make the trip, but when you know how much need is there, you feel beholden to help. I ended up traveling from Boston to Sierra Leone four times. It was very hard for me and my family. But this experience allowed me to put my skills to good use and helped improve the training I provide to U.S. healthcare workers. It has drawn me into a lot of policy discussions and scientific areas. It heartens me to see growing awareness about how to confront infectious disease threats better and earlier with initiatives such as the Coalition for Epidemic Preparedness Innovation and the Global Health Security Agenda. The world is hopefully waking up to the threat of emerging pathogens and everyday infectious diseases. —As told to Molly McDonough
Bhadelia is medical director of Boston Medical Center's special pathogens unit and director of infection control and medical response for Boston University’s National Emerging Infectious Diseases Laboratories.