A Step Away From the Past and Into the Present and the Future – An Old Doc’s Look at Health Care Reform

My son James recently sent me a link to a New Yorker article on health care delivery with this question: “Is Kaiser [-Permanente] like the Cheesecake Factory?” He might also have asked, “Is military medicine like the Cheesecake Factory?”

Health Care Reform - Change and Hope

In “Big Med - Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?”, Boston surgeon and medical writer Atul Gawande tries to apply the lessons he learned, as a result of a meal at a Boston-area Cheesecake Factory, to health care delivery. While noting that the Cheesecake Factory chain has managed – very well – to control both cost and quality while assuring an excellent customer experience, Dr Gawande points out that medicine doesn’t do nearly as well.

According to Dr Gawande, even in the erudite halls of Boston’s vaunted teaching hospitals – presumably models of the best medical care America has to offer – physician approaches to patient care are individualistic – even idiosyncratic; this results in patient complication rates that vary by as much as threefold within the same hospital; and patient / family experiences have historically been almost invariably wretched. While these hospitals may be at the forefront of research and innovation in health care, they don’t seem to be doing a very good job of delivering quality “every day health care” to “every day patients”.

What are the lessons health care could learn from Cheesecake Factory?

The first is a consistent – and consistently good – product. In the restaurant business, consistency means “standardization”, a consistent way of doing the same thing over and over again. My first lesson in medical consistency came during residency: I trained in a Chicago hospital that catered both to “carriage trade” patients and people from a very poor “mile-square” area in the City. In caring for our patients, our attending physicians very early on cautioned us to use the same care procedures for both the very rich and the very poor, because the instant we tried to “customize” our care (either for the rich or for the poor), we risked introducing opportunities for  medical mistakes. Undoubtedly, in medicine just as in the cooking business, you need to apply the individual judgement of a well-trained and experienced professional to each case. But doctors are notoriously a restive group, very protective of their independence. How do you get a “herd of cats” to practice in a consistent manner, even while permitting those individual judgment calls that hone the standardized approach to each individual patient’s needs? Here, I believe, is the first place my Kaiser-Permanente and my military experience becomes instructive. In both Kaiser and the military, practitioners are salaried. Thus, they aren’t competing with each other for patients and for income. I believe this makes for an environment that encourages true collegiality and a sense of “we’re all in this together”. When you combine true collegiality with a strong culture of “best practices”, I think it becomes relatively easier to develop a department-consistent (or even a hospital-consistent) approach to any aspect of medical care delivery. Of course, this takes effective leadership – something both the military and the Kaiser-Permanente model have spent some resources in cultivating.

Another lesson from my experience not necessarily highlighted in Dr Gawande’s piece is the importance of “doctor-based” decision-making. My favorite example comes from northern California Kaiser-Permanente. I was the chief of urology at my Kaiser hospital. At one of our quarterly Chiefs meetings at the Oakland, California headquarters of The Permanente Medical Group, the 13 of us were pondering a question brought to us by the Chief of the 13 Chiefs of Medicine: what should “company policy” be regarding the use of PSA screening for prostate cancer? Then, as now, with the possible exception of one or two very well circumscribed situations, the data are not at all certain. And then, as likely we would now, we argued the pros and cons at some length. Finally, with no consensus forthcoming, we turned in frustration to the representative from “Higher Headquarters” and begged “What do you want us to do?”. The answer was “You are the content experts. When you decide a policy, that shall be the policy of Kaiser-Permanente.” (We’d probably be urged, today, to look for a “best practice” model to follow, subject to change, of course, as experience and research refined our understanding of the medical matter at hand.) What a reassuring message I could bring back to my colleagues, and to my patients! No “bureaucrat” is making health care decisions for you!

Back to the Cheesecake Factory, Professor Gawande takes notice of the extensive use of computers, with screens at face level throughout the kitchens. These provide the company recipes and serving suggestions, readily accessible throughout all 160 restaurants in the chain. Both the military and Kaiser-Permanente have adopted extensive computer operations throughout their systems. In fact, Kaiser was looking to introduce system-wide computerized health care records and data sharing as early as the late 1980s. Computerized systems permit a secure sharing of medical information – lab test results, radiology images and medical history information – at every hospital and clinic in the system. The value of this is immeasurable in the reduction of unnecessarily duplicated tests and exams, and the easy discussion of such things as Xray images between specialists within the system. When my wife was facing arthroscopic knee surgery recently, her orthopedist just pulled her MRI images up on the screen right there in the exam room and went over them with her and me in detail! With the computerization of health records comes a similar easy collaboration between primary care provider and a specialist or specialists who might be located – at least in the military – half way around the world. The Kaiser organization offers an electronic version of a patient’s health record – on a thumb drive – that he or she can take on vacation, at nominal cost.

The Cheesecake Factory has an active product development establishment that produces an updated menu about every six months. Each of the military services has the equivalent – a research arm which searches for innovations in preventive medicine and the special health requirements of people operating in challenging environments whether that be in submarines, in space, or in the mountains of Afghanistan. The Kaiser-Permanente Division of Research, based in Oakland, California, has published more than 4000 peer-reviewed medical articles in its 50 year history. In 2010, its budget of nearly $100,000 supported more than 50 researchers involved in more than 200 research projects largely but not exclusively oriented to the health of large populations.

Both the military and the Kaiser-Permanente systems of health care offer a feature Dr Gawande doesn’t mention – the regionalization of very specialized care. For example, in northern California, Kaiser-Permanente’s more than 3 million patients receive their cardiac surgery at specialty centers in San Francisco and Santa Clara. Neurosurgical care is centered in Redwood City and in Sacramento.  The military system has similar echelons of care, from clinics to primary care hospitals to specialty hospitals. This regionalization avoids unnecessary duplication of expensive specialty care and equipment, and, as a bonus, assures that super-specialty surgeons and physicians are constantly busy – one determinant of successful outcomes.

Then there is the matter of “size”. The Cheesecake Factory, with its 160 restaurants, experiences economies of scale in purchasing of everything from eggs to refrigerators. The Department of Defense medical establishment is huge – the largest in the country. If if were so oriented, its huge purchasing power could effect amazing savings of scale. One example of Kaiser-Permanente marketplace power comes from some years ago. As the story goes, one domestic insulin manufacturer bought out its competition and then announced a large increase in the price of insulin. Promptly the northern California Kaiser pharmacy operation, as a major purchaser of insulin,  reached out to a large Scandinavian insulin producer and offered to partner with them to bring product to market in the US. This effort was successful, and the price of insulin dropped promptly.

Health care reform, in my view, requires one more thing that was implicit in Dr Gawande’s New Yorker restaurant piece: competition. Even while it was struggling to grow in its early years, the Kaiser-Permanente organization realized that healthy competition is a necessity. From the early 1940s, the Kaiser mantra became something like “unless patients have choices in the care they receive, we will have no opportunity to show how good we really are”. When I was practicing Navy medicine as a General Medical Officer, lo, those many years ago, I remember resenting my patients going to the doctors “downtown”, on the civilian side, for their care. I knew we were giving every bit as good care as the “townies” did, but the knowledge that our patients had a choice kept us all on our toes to do the best we could, even in the”captive” care system that is military care.

There you have it: consistency of medical procedures while encouraging the application of sound judgement; salaried health care providers to eliminate destructive competition and encourage collegiality and unity of approach; doctors- or professionals-driven policy decision-making based on consensus best practices; extensive application of computer technology to record keeping, data sharing and promulgation of consistent practice; regionalization of super-specialized care; scale of economy based on large regional or national systems of organization; and vigorous competition among provider systems.

By way of background, I practiced medicine in all three practice settings: active duty military (Navy, for 3 years), fee for service in a small multispecialty group (5 years), and in the large northern California Kaiser-Permanente Health Care system (20 years). In addition, with 20 years in the Naval Reserve, I had contact and conversations with physicians from around the country who practiced in a variety of settings. These experiences all convince me that a salaried system of care providers virtually eliminates the extra and often unnecessary medical procedures engendered by the fee-for-service model where a physician is paid for each procedure carried out. Fee-for-service puts the emphasis, in my view, on health care providers (the more procedures, the higher the income), rather than their patients and what’s best for them. It’s much more natural for salaried providers to be driven by what’s best for their patients, since salaries are going to be paid whether procedures are performed or not.

©2012 Thomas L Snyder

Walking the Walk

This weekend is the annual Mare Faire on Mare Island, site of the first naval base on the U S Pacific Coast. Mare Island also was the home of the first Naval Hospital on the west coast. Opened informally – housed first in an unused granary – in 1864, the hospital closed in 1957. The Navy Schools Command operated the facilities until the Navy Base closed in 1997. Touro University took possession of the property in the early 2000s.

Mare Island Naval Hospital, 1871 (Image: National Archives)

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The Mare Faire is my annual opportunity to tell the story of Naval Hospital Mare Island, California, to visitors from around the country. This weekend, both on Saturday and Sunday, I give a one hour PowerPoint® presentation, Mare Island’s Hospitals–Mare Fair 2012Aug11-12. Then, I lead a walking tour of the hospital property, which is today owned by Touro University California. with the exception of one building used for instructional spaces, and three for administration an faculty offices, the original hospital structures lie empty and unused. While university officials won’t allow us access to the interiors, we are permitted to walk the hallowed grounds where wounded and sick sailors and Marines walked for nearly 100 years.

So this weekend, I literally talked the historical talk and walked the historical walk.

©2012 Thomas L Snyder

Navy Medicine in the War of 1812 – Action in the Year 1812, Part I

War of 1812 Propaganda Poster (Image: Ohio History Central. http://www.ohiohistorycentral.org/entry.php?rec=565)

The history community in the US and Canada (I don’t know about the UK) are ramping up for observations of the 200th anniversary of the War of 1812. Inasmuch as this war was in large part fought on water, it occurs to me that we should be looking, so far as we can, at the role navy medicine played in the conflict. For Part I of this discussion, I will depend largely on Professor Harry Langley’s 1995 book A History of Medicine in the Early U.S. Navy.

You’ll recall that British had raised the ire of Americans by their interference in our commerce with Napoleonic Europe, and, more importantly, by their impressment of American mariners into the Royal Navy. Initially, the US Congress retaliated with legislation – the Embargo and Non-Intercourse Acts of 1807 and 1809 – but these further decreased our overseas trade.  With New England merchants crying economic ruin, first the House (79-49 on June 4, 1812), then the Senate (19-13 on June 17) voted for war, and President Madison signed the Declaration on 18 June.

Commodore John Rodgers’s quickly assembled a squadron of four ships. Soon after they departed New York, on 25 June, they encountered HMS Belvidera, 36, northeast of New York. A brief but violent action followed, with USS President, 44,  pursuing. In the end, Belvidera ran north to Halifax, having sustained the loss of 2 killed and 22 wounded. President, the only American ship to engage, experienced 3 killed and 19 wounded. Langley says “…its surgeon and mates cared for the wounded.”(1)

Commodore Rodgers and his squadron proceeded to patrol within a day’s sail of the English Channel. Despite success in capturing British merchant ships – he had 80 – 100 prisoners aboard – the squadron had to return home to Boston earlier than planned because of a widespread outbreak of scurvy among his crews.(2) Langley says that his crews were hospitalized at the Boston Navy Yard, but this care must have been given in the Marine Hospital, because a Navy hospital in Boston was not constructed until 1836.(3)

USS Constitution meets HMS Guerriere (Image: U S Naval History and Heritage Command)

On August 19, USS Constitution won a celebrated victory over HMS Guerriere. Constitution suffered 7 killed and 7 wounded while her adversary lost 15 dead and 62 wounded. Surgeon Amos A Evans(4) and Surgeon’s Mate John D Armstrong attended the American injured; when the fighting was over, the two men transferred to Guerriere to assist her surgeon, who himself had been wounded, in the care of British sailors. Professor Langley gives us an interesting detail of Evans’s care of an amputee, one Richard Dunn. Two days after his surgery, when the patient complained of stump pain, Evans “wetted it with laudanum and gave the patient laudanum mixed with wine”.(5)

In October, November and December, ships in the American navy fought three more sea battles (I’ll write about lake battles later in this series) resulting in injuries cared for by naval surgeons. Stand by for future posts.

(1) Langley, Harold D., “A History of Medicine in the Early U.S. Navy”, Baltimore, Johns Hopkins Press, 1995, p 176.
(2) It is curious that scurvy should have been seen in large numbers at this late date, as the disease had been virtually eliminated from the Royal Navy by 1800, due to the common acceptance – by medical officers and commanders alike – of citrus juice as an effective antiscorbutic. The discussion of the conquest of scurvy in the Royal Navy by Lloyd and Coulter (Lloyd, Christopher, and Jack L S Coulter, “Medicine and the Navy, 1200-1900. Volume III–1714-1815″, Edinburgh and London, Livingstone, 1961, Chapter 18) is comprehensive.
(3) Langley tells that Congress appropriated $15,000 for a hospital in Boston to care for all sailors, both merchant mariners and navy sailors in 1802. The Boston Marine Hospital was constructed in 1803, and received its first patients in January 1804. The Marine Hospitals were operated by the Secretary of the Treasury; Navy officials came to believe this was an unsatisfactory arrangement because navy sailors had a propensity to desert from these places as they recovered from their illnesses or injuries. A Naval Hospital Fund, intended to pay for construction of hospitals specifically for the Navy, was passed in February 1811 and immediately funded with $50,000 transferred from the Marine Hospital Fund. The War of 1812 interrupted plans to build a Naval Hospital in Boston. It finally saw fruition in 1836. http://www.nps.gov/nr/travel/maritime/nav.htm accessed 4 August 2012.
(4) According to a brief University of Michigan biography, Evans studied medicine with a hometown practitioner “and attended lectures by Benjamin Rush in Philadephia”. He was admitted to the Navy in 1808, served in the naval hospital in New Orleans, in USS Constitution. While on shore duty, he earned his MD from Harvard in 1814. In 1815, he was promoted to be the navy’ s first Fleet Surgeon. He resigned from the navy in 1824. http://quod.lib.umich.edu/c/clementsmss/umich-wcl-M-262eva?view=text, accessed 3 August 2012.
(5) Langley, pp 177-178. Laudanum – tincture of opium – is a powerful narcotic pain medication. In his “Materia Medica and Therapeutics” (Philadelphia, F A Davis, 1891), John V Shoemaker, AB, MD, describes its beneficial application to wounds as “an antiseptic and to relieve pain”. http://books.google.com/books?id=SqBmb4sJKoIC&pg=PA783&lpg=PA783&dq=topical+laudanum&source=bl&ots=kL0jaQRZP4&sig=FknCNMtEPs3HcW-HAorPYvDeYTI&hl=en&sa=X&ei=2oUcUImjLMiuiALs3YGABA&sqi=2&ved=0CFAQ6AEwCA#v=onepage&q=topical%20laudanum&f=false accessed 3 August 2012.

©2012 Thomas L Snyder

U S Naval Receiving Hospital San Francisco California, December 1944 – December 1945

One of the joys of being the Executive Director of the Society for the History of Navy Medicine is that, on occasion, a person will find me on the internet and offer to share something about a relative who served in the Navy, typically, in World War II.

Such was the case when I received an email from the daughter of Ken Crawford, PhM2, USNR. Ms Crawford made mention that she held her dad’s “Anniversary Booklet” for the United States Naval Receiving Hospital, San Francisco, and asked where she might donate it. I  referred Ms Crawford to the archivist at the Navy’s Bureau of Medicine and Surgery, in Falls Church, VA. But first, I asked if I might have an opportunity to see the booklet for my own research purposes. The little treasure arrived in my mail today.

U. S. Naval Receiving Hospital (Fleet Hospital No 113), San Francisco, California, 1944-1945 (From the hospital Anniversary Booklet

According to the Booklet, the hospital was originally assembled at the Medical Supply Depot in Brooklyn, and later expanded “in echelons” at the Naval Supply Depot in Mechanicsburg, Pennsylvania. Shipped to California  in September, 1944, the hospital’s 61 “task force-type” buildings found their home in Crocker Amazon Park, at Geneva Ave and Moscow Street in San Francisco.  Commissioned on 9 December 1944, the hospital staff included 11 medical officers, 4 dental officers, 50 nurse corps officers, 11 hospital corps officers, 10 pharmacists, 2 chaplains, 2 supply officers and a Marine Corps officer and more than 600 enlisted people including (more than 500) pharmacists’ mates, storekeepers,  seamen, Marines, and 43 cooks. The number of patients this seemingly ample staff served is not noted in the Anniversary Booklet. The hospital’s missions were to receive overseas casualties, provide hospital services for nearby naval activities and “to act as a training center for newly indoctrinated medical officers and hospital corpsmen”.

As Robert C Fenning, LT (jg), Chaplain Corps, USNR wrote in the booklet, “To the returning casualty Fleet Hospital 113 was a pause for adjustment. On home soil again, he could offer thanks…” The hospital offered a full agenda of entertainments and activities including stage shows, celebrity visits (Walter Winchell, Jack Dempsey, Helen Hayes and Eddie Foy, Jr. are specifically mentioned), dances and sports activities.

“Receiving Examiner” for December 6, 1945

With the war over and patients eager to go home, the hospital was scheduled for decommissioning on 15 December 1945, just a year and a week after its commissioning. According to the ParkScan website, the Navy vacated the site in 1946, and the structures turned over to the San Francisco Housing Authority for use as veterans’ housing during the post-war housing shortage. The park returned to recreational usage in 1957.

©2012 Thomas L Snyder

 

 

 

 

 

 

Former Navy Surgeon General Named New AMSUS Executive Director

The Society for the History of Navy Medicine has a relationship with AMSUS in that he have mounted a panel at the organization’s annual meeting and plan to do so in future. Given that, the announcement here should be of interest. I received it in this morning’s email traffic.

The AMSUS Board of Managers is delighted to announce the selection of retired Vice Admiral Michael Cowan to serve as AMSUS Executive Director. Doctor Cowan will follow retired Major General George Anderson in this key leadership role. Doctor Anderson has served as Executive Director since 2005 and will complete his time at the helm in November, 2012.

AMSUS is the Society of Federal Health Professionals. The society was organized in 1891 and chartered by Congress in 1903 to advance the knowledge of healthcare within the federal agencies and to increase the effectiveness of its members. It is dedicated to all aspects of federal medicine – professional, scientific, educational and administrative. Presently our nearly 8,000 members represent all healthcare disciplines and serve in the Active and Reserve Components of all of the uniformed services as well as the Department of Defense and the Department of Veterans Affairs.

AMSUS will host its 118th Annual Meeting in Phoenix this fall, and Admiral Cowan will become Executive Director following that convention. He will continue to serve on the AMSUS Board of Managers and as the AMSUS Awards Committee Chair until he assumes his new role.

Prior to retiring from the Navy Admiral Cowan served as the 34th Naval Surgeon General and Chief of the Navy Bureau of Medicine and Surgery. Since retirement from the Navy he has been a professional services and information technology consulting executive for Oracle, Inc., BearingPoint, Inc., and currently at Deloitte Consulting LLP.

BG Michael J Kussman, MC, USA (Ret.)

Chair, AMSUS Board of Managers

Rum In the Navy

Two weeks ago, I related the urban legend of how Lieutenant – later Rear Admiral – Lucius Johnson, Medical Corps, U. S. Navy, introduced the rum-based daiquiri to Washington DC society in the late 19th century. I want now to briefly review the history of rum in the Navy.

“Rum had always been the naval drink, since beer and water did not keep at sea…” wrote Lloyd and Christopher in their definitive history of British naval medicine, “and gin was largely confined to the land, or to the wardroom.” When Admiral Sir Edward Vernon arrived in the West Indies in 1740, he was taken with the “swinish vice of drunkenness” he saw there. After consultation with his surgeons, Vernon hit upon the notion of diluting the rum ration with water as a way of reducing its intoxicating effect. The formula Vernon (referred to as “Old Grog” for the Grogram water-proof cloak he habitually wore) specified in the order he issued to his ships’ commanders was a quart of water added to the sailors’ half-pint daily rum ration. Thus was the famed navy grog invented.(1)

While Admiral Vernon’s innovation was widely adopted, Naval surgeons fretted and Admirals thundered about the “crime of drunkenness” throughout the 18th century. While floggings and other punishments were instituted in attempts to quell the widespread problem, another reforming Admiral, Lord Keith wrote in 1812, “…it will be impossible to prevent [it] so long as the present excessive quantity of spirits is issued in the Royal Navy; for men seem to have no other idea of the use of spirits than as they afford them the means of running into excess and indulging in intoxication”(2) According to Lloyd and Christopher, it was only with the changing mores incident to the Victorian era that abuse of spirits decreased. Cocoa became the more popular “pick-me-up” in the Royal Navy.

Despite the Revolution, our Navy adopted many customs of the Royal Navy, including the rum ration. As one naval history source(3) puts it, “[i]n the early days of the U.S. Navy rum was a part of daily life and the grog ration was a half-pint a day. During the days of Constellation there was a saying that showed the importance the men placed on their daily ration of grog. This saying was: “Blow up the magazines; throw the bread over the side and sink the salt horse – but handle them spirits gentle like.”

Late 19th Century Navy Copper Measures. Smallest is 1/2 Gill. U S Navy daily ration was 2 gills (Photo: http://www.thepirateslair.com/4-us-navy-copper-measures-1.html)

By the 1820s, the nation began to develop a predominating opinion toward temperance. The House of Representatives reflected this emerging sentiment by adopting a petition to encourage the Secretary of the navy to assess the effects of alcohol upon the service.  John Branch (served as Secretary of the Navy 1829-1831 tasked Surgeons Heerman, Barton and Harris the task of evaluating whether the grog ration was a “naval necessity”. Presumably reflecting informed medical opinion of the day, all three believed the grog rations “was unnecessary and harmful to morals and health”, and “subversive to discipline”. These experts recommended to the House of Representatives that sailors be encouraged to commute their spirit ration by being paid a generous sum of money as a means voluntarily reducing alcohol consumption.(4) Branch’s successor Levi Woodbury instituted this reform in 1831, setting the commutation rate at 6 cents per day.

In succeeding decades, despite multiple pressures for reform, the grog ration was not officially ended until 1862, by an Act of Congress passed 14 July. Personal stores of alcohol, the officers’ wine mess and alcohol retained for medicinal purposes and under control of the Surgeon were still permitted. It was not until 1 July 1914 that Secretary of the Navy Josephus Daniels’s General Order 99 prohibited “the use or introduction for drinking purposes of alcoholic liquors on board any naval vessel, or within any navy yard or station”. Medicinal alcohol is still retained. Your author, in destroyer service during the Vietnam conflict, had occasion to break out the medicinal brandy to reward a crew for rescuing a man overboard in hazardous conditions.

1. Lloyd, Christopher, and Jack L S Coulter, “Medicine and the Navy: 1200 – 1900 Vol III”, London, E & S Livingstone, 1961, p 88ff.
2. Quoted in Lloyd and Coulter, above, p.90
3. http://www.history.navy.mil/faqs/faq78-1.htm#anchor94512, paragraph “Grog”, accessed 23 July 2012.
4. Langley, Harold D., “A History of Medicine in the Early U. S. Navy”, Baltimore, The Johns Hopkins Press, 1995. pp 294-295.
 
©2012 Thomas L Snyder

Brief Sabbatical: Your Correspondent a New Rotary Club President

Dear Readers,

I’m going to take a brief sabbatical from these federings: I just took office as the first president of a newly chartered Rotary club.

Rotary Club of Solano Sunset Inaugural President Tom Snyder Strikes the Bell for the First Time. Note that “Peace through Service” is RI’s 2012-2013 byword.

It’s a “new-model club” designed to meet the needs of today’s younger, busier Rotarians: we meet during commute hour, for 45 minutes only; hors d’oeuvre, no sit-down meal; youngish (you wouldn’t know it by looking at the club president…); about a third of members are married couples; ~50% women; high energy – and as a new club, we are setting our own precedents as we go along. Needless to say, a lot of planning needs go into our first few weekly meetings. On top of that, we will have a big blow-out Chartering Celebration at the end of the month, and there’s much planning for that!

I think I’ve written a bit about Rotary International before. Despite its image as a social club for old white guys, “RI”, as it’s known, is much more than that. There are about 1.2 million Rotarians in something like 34,000 clubs in most countries of the world. The Rotary motto is “Service Above Self”, and this mantra manifests itself in innumerable local community projects (Rotarians seem to favor things like literacy, child and maternal health, community sports and recreational facilities) and international work.

It’s in International Projects that Rotary multiplies its impact, by working with Rotarians “on the ground” in regions of need. With sustainability as a central criterion, Rotary clubs in more wealthy nations work with local clubs in Africa, Central and South America, India and even China (though Communist nations are wary of involvement with such a “Capitalist” icon as Rotary) to create safe water supplies, open and maintain health clinics, start and sustain elementary and secondary schools, and much, much more.

On top of individual club-to-club efforts, Rotary as an institution funds a huge youth exchange program. Each year, RI and individual Rotary clubs sponsor about 8,000 international student exchanges. High school students, usually in their junior or senior years, travel to a host nation for a year of school and cultural experience. Local Rotary clubs host these students, and local Rotary families house them. Rotary also sponsors an international Peace and Conflict Resolution program in partnership with universities in Thailand, Japan, England, Austrialia, Sweden and the US. More than 500 Peace Fellows have graduated from these programs; many have gone on to establish peace and conflict resolution programs in their own locales.

Since 1947, Rotary International has sponsored more than 41,000 Ambassadorial Scholarships for undergraduate, graduate and vocational education all around the world. While studying in their host countries, Rotary Ambassadorial Scholars act as goodwill ambassadors for their home countries; when they return to their homes, they become ambassadors of their host countries while applying the knowledge they gained from their Ambassadorial studies.

Finally, there’s Polio Plus. This Rotary program to eliminate the scourge of Poliomyelitis from the entire world started with a successful project  initiated by two Filipino Rotarians. Then, 25 years ago, Rotary International adopted the idea and took it “international”. Along the way, RI teamed up with the Centers for Disease Control and the World Health Organization, while Rotarians and their friends “on the ground” strove to immunize billions of children and adults. In India, for instance, immunized kids receive an indelible black ink mark on a finger. Then, Rotary workers flood train stations and other gathering places calling out “show me your finger!” Kids who don’t have the marked finger receive the oral vaccine on the spot. Last year, India was taken off the list of nations with endemic polio. Now only Nigeria, Afghanistan and Pakistan remain. The Taliban institutes cease-fires when Rotary teams arrive in villages to immunize the residents. This past year, Rotarians contributed more than $215 million in response to a Bill and Melinda Gates Foundation challenge. The Challenge having been met, the Foundation kicked in $355 million – its largest grant to date. That means Rotary and its partners now have more than $570 million to finance the final push to eradicate polio.

Rotary International

Interested in becoming a Rotarian? We are a by-invitation-only organization. Contact a Rotarian you know to talk about joining a local Club. I believe you will not regret becoming a part of such an important Force for Good in the world. Don’t know a Rotarian? Just look for the Rotary pin (identical to the logo, above) that most Rotarians wear with pride on their lapels or collars.

©2012 Thomas L Snyder

Not Quite #HiggsBoson Here…

The world of science is all aTwitter (sorry) about CERN’s announcement this week that they have confirmed the existence of the long-predicted Higgs Boson. See this video for a quirky explanation of the importance of the phenomenon.

Our historical discovery this week isn’t in Higgs Boson league, but it’s quirky, I think. It comes to us from several commentaries on the American landings in Cuba during the Spanish-American War. For reasons the tacticians will have to weigh in on, US troops landed at a coastal town near Santiago de Cuba. Turns out there was an iron mine in the area, manned by U S engineers. These yanquis apparently adopted a local Cuban concoction of rum, lime juice and sugar and added the innovation of ice, thereby creating a libation suitable for relaxing after a hard day in the mines. Urban legend holds that a U S Navy medical officer, LT Lucius W Johnson, fell in with the engineers and became enamored of the cooling, soothing combination.

Americans landing at a pier near Santiago de Cuba. From p. 318 of Harper’s Pictorial History of the War with Spain, Vol. II, published by Harper and Brothers in 1899

So pleased was he with his finding – no doubt Johnson appreciated a good scurvy preventative when he saw one – that the good doctor brought the recipe – plus a good stock of rum – back to the States with him, and introduced the drink to his friends at the Army Navy Club in Washington DC. Thus, according to legend, was the daiquirí introduced to American tiplers. The drink became especially popular during World War II, when, with encouragement from FDR’s Good Neighbor Policy, importation of rum made that important daiquirí component especially plentiful and cheap.

Historians – and internet commentors on drink – don’t comment on what role, if any, Johnson’s association with the daiquirí played in his subsequent promotion to Rear Admiral, Medical Corps.

The Daiquirí

Recipe for a Classic Daiquirí:

60 ml white rum (dark rum is too sweet)
30 ml fresh lime juice
1 tsp sugar
Shake over cracked ice until very cold, then strain into a martini glass. Garnish with a lime wheel if you wish.
Sounds perfect for a hot summer afternoon.

©2012 Thomas L Snyder

In Naval History, People Arrive and People Depart

Last week, I was in Washington DC for a family visit. While there, I was witness to a significant “coming” and a significant “going” in Naval history.

Captain Henry J Hendrix II, USN

At the weekend, I attended the Naval Historical Foundation annual meeting. Introduced there was the new  (“interim”, or so he’s characterized on his LinkedIn page) Director  (as described on its website) of Naval History at the Naval History and Heritage Command,  Captain Henry J Hendrix II, USN. Captain Hendrix actually was appointed to his post in May. He told me he had a two-week in-brief by his predecessor, RADM Jay DeLoach before stepping in to the leadership role at the Navy’s flagship historical establishment. Captain Hendrix has Masters Degrees in National Security Affairs – Middle East (Naval Postgraduate School) and History (Harvard), and a PhD in War Studies (University of London). He’s an adjunct Assistant Professor at Georgetown, where he teaches a course in strategy, policy, technology and security in government. He’s written for the Naval Institute for more than 10 years, and recently, Captain Hendrix served on a board offering strategic advice to the Secretary of the Navy. All this seems good preparation to lead the organization that’s responsible for accessing, restoring and preserving an immense amount of documents, artifacts and (now) electronic records of historical importance to our Navy and Marine Corps.

Jan Herman

Also while in the DC, I attended a celebration for Jan Herman, who has retired after 33 years as Historian of the Navy Medical Department and editor-in-chief of its journal, Navy Medicine. Jan started his 42 years of federal service with a tour in the Air Force. He then joined the State Department as a public affairs writer and staff assistant.  After coming to the Bureau of Medicine and Surgery, Jan curated the organization’s then-headquarters, the Old Naval Observatory located in the Foggy Bottom area of Washington DC. During his tenure, Jan wrote several books including Battle Station Sick Bay: Navy Medicine in World War II; Frozen in Memory: U.S. Navy Medicine in the Korean WarNavy Medicine in Vietnam: From Dien Bien Phu to the Fall of Saigon; and The Lucky Few: The Story of USS Kirk. More recently, he has become a media magnate, having produced a six-part documentary Navy Medicine at War and The Lucky Few: the Story of the USS Kirk. Jan also oversaw the Navy Medical Department’s oral history project for more than 25 years. Despite his retirement from federal service, Jan insists that he will remain active in the history field. Right now he’s working on a novel about the Civil War and its aftermath.

On a personal note, this week I was installed as the first president of the newly chartered Rotary Club of Solano Sunset-Vallejo (California). I am humbled to have been elected to support our 30 mostly new Rotarians as they join 1.2 million other Rotarians throughout the world working to eliminate polio from the world through Rotary International’s “Polio Plus” program. In the 20+ years since Polio Plus was launched, the dread disease has been eliminated from every country in the world except Nigeria, Pakistan and Afghanistan. Rotarians throughout the world also work to support local charities, international scholarships (where Rotary is larger by far than , for instance, the Fullbright program) and a huge variety of other projects both local and international.

 

©2012 Thomas L Snyder

Medical Medal of Honor Awardees – Battle of Belleau Wood

This week we observe the Battle of Belleau Wood (6 June to 6 July 1918).  The 1st and 2nd Battalions, 5th Regiment, U S Marine Corps fought in this iconic World War I battle as part of the American Second Division. Their initial mission was to block a German advance toward the French capital along the Metz-Paris road. Once the German advance had been stopped, the Marines were directed to displace a determined German force from Bois de Belleau on the German salient. Fighting was extremely vigorous, with American forces crossing land covered by murderous German machine gun fire. The Wood changed hands 6 times in a month of brutal action. Navy Secretary Josephus Daniels described the fighting thus:

The marines fought strictly according to American methods – a rush, a halt, a rush again, in four-wave formation, the rear waves taking over the work of those who had fallen before them, passing over the bodies of their dead comrades and plunging ahead, until they, too, should be torn to bits.  But behind those waves were more waves, and the attack went on.

“Men fell like flies,” the expression is that of an officer writing from the field.  Companies that had entered the battle 250 strong dwindled to 50 and 60, with a Sergeant in command; but the attack did not falter.  At 9.45 o’clock that night Bouresches was taken by Lieutenant James F. Robertson and twenty-odd men of his platoon; these soon were joined by two reinforcing platoons.”(1)

Two Naval medical department officers serving with Marines were awarded the Congressional Medal of Honor for valor during that month of intense action.

The first (6 June 1918) was LT(jg) Weedon E Osborne, Dental Corps, USN. His Medal of Honor Citation reads:

LT(jg) Weedon E Osborne, DC, USN

“For extraordinary heroism while attached to the Fifth Regiment, United States Marines, in actual conflict with the enemy and under fire during the advance on Bouresche, France, on 6 June 1918. In the hottest of the fighting when the Marines made their famous advance on Bouresche at the southern edge of Belleau Wood, Lieutenant, Junior Grade, Osborne threw himself zealously into the work of rescuing the wounded. Extremely courageous in the performance of this perilous task, he was killed while carrying a wounded officer to a place of safety.”(2)

Medical Corps officer LT Orlando H Petty, US Naval Reserve Force, received the award for valorous service when his battle aid station was gassed on 11 June 1918. His citation says:

LT Orlando H Petty, MC, USNRF

“For extraordinary heroism while serving with the Fifth Regiment, United States Marines, in France during the attack in Bois de Belleau, 11 June 1918. While under heavy fire of high explosive and gas shells in the town of Lucy, where his dressing station was located, Lieutenant Petty attended to and evacuated the wounded under the most trying conditions. Having been knocked to the ground by an exploding gas shell which tore his mask, Lieutenant Petty discarded the mask and courageously continued his work. His dressing station being hit and demolished, he personally helped carry Captain Williams, wounded, through the shellfire to a place of safety.”(3)

Petty survived the war, but died young, in 1932.

Four other Navy medical department personnel received Medals of Honor for valor during World War I: Alexander G Lyle, LCDR, DC, USN; Joel T Boone, LT, MC, USN; David E Hayden, Hospital Apprentice 1st Class, USN; John H Balch, Pharmacist Mate First Class, USN.(4)

 

(1)  “firstworldwar.com – a multimedia history of world war one”, Primary Documents – Josephus Daniels on the Battle of Belleau Wood, June 1918, http://www.firstworldwar.com/source/belleau_daniels.htm, accessed 21 June 2012.
(2) Naval Historical Center [{U S} Naval History and Heritage Command], Online Library of Selected Images – People – United States: Lieutenant (Junior Grade) Weedon E. Osborne, USN (Dental Corps), 1892-1918, http://www.history.navy.mil/photos/pers-us/uspers-o/w-osborn.htm, accessed 21 June 2012. Both the citation and the image can be found on this site.
(3) [U S] Naval Historical and Heritage Command, Lieutenant Orlando H. Petty, Medical Corps, USNRF (1874-1932), http://www.history.navy.mil/photos/awd/us-indiv/petty/o-petty.htm, accessed 21 June 2012. Both the citation and the image are found on this page.
(4) [U S] Naval Historical and Heritage Command, Navy Medal of Honor, World War I, 1918 [sic], http://www.history.navy.mil/faqs/moh/moh13.htm, accessed 21 June 2012. This list records Navy and Marine Corps Medal of Honor awardees for both 1917 and 1918

©Thomas L Snyder