Eric Johnson, PA-C’98, left, began the 350-mile Iditarod Trail Invitational on Feb. 27 at 2 p.m. and finished on March 6 at 3:53 a.m.

If it looks cold, that’s because it is.
And if it looks crazy, that’s because it is.

This is Alaska, ensnarled in the crushing embrace of an Old Man Winter that’s about to lose his grip, but not without one last desperate grab. And there beyond the wind-whipped red and white sign that reads, “Alaska Ultra Sport,” is 350 miles of sketchily marked trail, over rivers, through forests, and up mountain passes.

This is the Iditarod Trail Invitational – 350 (or 1,100 if racers went on odd-numbered years) miles of the storied dogsled race done with bike, skis or feet. As far as ultras go it’s the mother of crazy.

One week before the dogs run, Ogden, UT, resident Eric Johnson, PA-C’98, hooks up his self-made sled (a duffle bag top riveted to a red child’s sled) and befriends crazy for a little less than a week as he solotreks the race. He befriends crazy, and tells her he’s got a handle on the situation. In fact, Eric Johnson puts crazy in a corner.

“Really, it’s insane,” said Johnson, who has finished the race five times, winning the foot portion of the race two years in a row. The divorced father of three kids ages 16, 14 and nine finished the race this year in six days, 13 hours and 54 minutes.

“I just enjoy doing it. The thing about this race is that if you can really get a solid, firm foundation and suffer through hard workouts, the race is actually really quite fun.”

For Johnson, a physician assistant at Ogden Clinic, the fun this year included traveling the first 90 miles sans sleep in 27 hours, with just an hour stop at the first checkpoint, at mile 60, for breakfast. After five hours of sleep, he was back out the door at 10 p.m. for another 40 miles. About 10 miles into it, Johnson started to sink into himself and some misery. It was then that he developed a mantra that helped him get through the race.

“‘Five is alive,’ I thought of that,” he said. “I wanted five finishes, one for each finger. There’s something special about five, not four; five. It really was motivating for me. It was born of the trenches, too.”

As the sun rose, both literally and emotionally, Johnson began to get into his hiking rhythm. Most of the race is hiking, hiking, slogging and more hiking, with maybe 10 percent running – which is still more miles than a marathon.

Johnson used the next checkpoint, at mile 140, to refuel.

“I pounded about 2,500 calories in five hours. I had four cans of Ensure and one huge dinner. I didn’t sleep any, it was just food, food,” he said. “There’s a saying on the trail that calories are king. You’re seriously burning through 8,000 calories a day.”

Eric Johnson is one of only three people in the world to have completed the ultra event on foot five times.

While Johnson carries 1,600 calories of concentrated fruit juice in the Camelbak and is constantly consuming snacks like bread slathered with butter, cookies and crushed-up bags of potato chips, his output during the race still exceeds his input.

“I’m five-foot-nine and I start the race at about 165 [pounds] and finish at 155. I’ve lost two belt loops. Usually I gain it back within a couple months. That’s pretty common,” said Johnson.

At the 140-mile checkpoint, the race enters the Alaskan range for the next 100 miles, and many racers consider this the crux of the race. It includes a checkpoint at the legendary Rainy Pass at 165 miles.

“It’s famous for really bad storms, but really good hospitality,” said Johnson. “It’s amazingly beautiful, and it also has some very difficult sections of trail. Those sections of the Iditarod Trail are famous for being very, very hard, with horrible weather and bad conditions. It’s built kind of a reputation.”

Johnson spent four and a half hours at the 165-mile checkpoint, leaving just 15 minutes behind Pennsylvanians Tim and Loreen Hewitt, a married couple on foot that was just managing to stay ahead of him. At the 210-mile checkpoint, Johnson was able to sleep four hours and left Friday morning, still behind the Hewitts.

From there, Johnson trucked another 90 miles without sleep. Arriving Saturday morning at the 300- mile checkpoint, a small Native village called Nikolai, accessible only by snowmobile, boat or airplane (or by foot), he slept about four hours, ate breakfast and then broke for the finish line.

He caught Tim, who had gone on ahead of his wife by that time, at about mile 310.

“I said, ‘Hey, Tim, I’m not going to let you have all the fun alone.’ And he said, ‘Let’s go in together.’”

Johnson said the conditions were so nice this year, only -30 degrees Fahrenheit, that he didn’t ever break out his expedition parka, or extra hood and gloves. One of the Spartan rules of the race is that competitors must carry their survival gear from start to finish. They’re allowed two drop bags at miles 140 and 210, but those bags can only contain consumables, such as food and batteries.

Johnson carries just the essentials, keeping his sled as light as possible, around 30 pounds. That includes clothing, a two-pound sleeping bag that can double as a parka, a headlamp, duct tape and quick, light meals. He carries no stove or GPS. His only extravagance is an extra pair of shoes. He wears running shoes with snowmobile studs screwed in for traction.

“You have to be comfortable,” he says without a trace of irony. “I’m a minimalist. You have to travel relatively fast. If for some reason your feet get wet, and you have an extra pair of shoes, you can keep moving. But go light, go fast.”

No required gear-list hinders this race. Bill Marchant, the trail manager, is also a minimalist. The race philosophy, posted on the Alaskaultrasport.com website, reads, “We all agreed support should be kept to a minimum. Winning or even finishing in the extremes of Alaskan winter weather depends on how comfortable the racers are with their abilities, level of experience and amount of risk they are willing to take.”

This philosophy gives racers the chance to walk the razor’s edge of adventure and adrenaline. The race is a puzzle that, if solved correctly, results in the only real triumph, man vs. the wild, but if miscalculated, could result in death.

Johnson, 45, has proven adept at solving the race’s puzzles, getting only minimal injuries (he’s had surgery on a toe on his right foot, and carpal tunnel surgery from the vibrations of the trekking poles). He’s super-modified his race gear (his layers of clothing are a patchwork of sewn-in and glued-in extra fleece, zippers, added fur and duct tape repairs). And only once has he called it quits (during the race in 2007, when he broke through the ice at a river crossing and was soaked).

“You take the good with the bad,” said Johnson. “The thing about the race is you get these crazy lows, these wicked bad lows. Those you just have to grind through, but overall it’s fun. The reason I do it is because I enjoy it, and it’s fun.”

He says this casually, as if racing 350 miles isn’t work. And for him it isn’t. In 2010, finishing with the second-fastest foot time in the history of the course (five days, 17 hours), he discovered an attribute of pain.

“Last year, the thing I walked away with was that physical pain has this ability to purify a person spiritually. I know that sounds crazy,” he said.

Johnson knows he’s a different breed from most people, concluding that races like these take an introvert, someone comfortable with being alone in difficult circumstances. And it takes someone who knows that racing this far in these circumstances is akin to Van Gogh creating a masterpiece.

“This year the take-home message is that it’s important to have a goal, but the person is not there to serve the goal. Really, the goal is there to serve the person. Goals serve the purpose of focusing our talents and ability, and they channel that into a focused effort, to accomplish a worthwhile activity.”

Johnson plans to do a few short races this summer and then run the Wasatch 100 in Utah for the 10th time.

After the Iditarod 350, running 100 miles through the Wasatch Range seems safe – and almost sane.

The premise: We have too much; we use too much!

Health care reform in the United States is a topic that will not go away. Indeed, rather than putting the issue to rest, the passage of the Patient Protection and Affordable Care Act (PPACA) appears to have simply moved the matter out of the hands of lawmakers and into the arms of the courts. As of this writing, most expect the legality of all or part of the act to be resolved by the Supreme Court. However the Court rules, few expect health care reform to quietly fade into the background.

PPACA’s overarching goal is to expand access to health insurance for most Americans. The law’s principle focus is on health insurance reform, attempting to make it easier for consumers to obtain and retain health insurance. In many cases,the law will provide federal subsidies to help pay for this expanded coverage.

Further, the law seeks to encourage medical providers to become more “efficient” by promoting such concepts as medical home, accountable care organizations and expanded health promotion. One assumes that this drive for efficiency is to help make health insurance more affordable, by reducing, on average, the amount of medical services consumed by the average consumer.

In short, the law sets the ambitious goal of expanding insurance coverage for the many, while restraining overall utilization of medical services, the cost of that care, or both. As one can imagine, this is easier said than done.

However well intended, this focus on expanding coverage and reducing utilization and costs is predicated on certain assumptions about U.S. medical care that are not well founded. The first is that Americans utilize medical services at a level that is, put simply, wasteful. Clearly, “everyone knows” we Americans spend more money on health care than any other country in the world, and yet we do not compare favorably to other countries on such indicators as infant mortality and life expectancy. The assumption here is that these facts indicate a degree of waste that can no longer be tolerated.

The second assumption follows from the first. As more Americans obtain insurance and seek access to more medical services, existing care providers have the extra capacity or resources to deliver these services upon demand. In this instance, the capacity I refer to are the quantity of practicing physicians and the number of licensed inpatient hospital beds.

Again, this assumption of resource availability seems reasonable. “Everyone knows” we lead the world in hospital resources, medical technology and the number and quality of our physicians. We have the best medical schools and world-famous hospitals, so where is the problem?

The problem is that these assumptions may not be valid. As an economist, I was taught to always ask the question, “As compared to what?” So I recently went off in search of data that might help us determine if these assumptions are valid or more like wishful thinking.

The data: America’s resource profile and utilization rates suggest we may already be rationing medical care

The tables provide selected data from the Organization for Economic Co-operation and Development (OECD) for the seven largest developed countries in the world⁷. In brief, this is what medical resource data suggest about the U.S.: As expected, the U.S. leads the world in health care spending as measured as a percentage of Gross Domestic Product and health care spending per capita.

With regard to medical resource availability, the U.S. looks quite modest in several key areas. Consider that we have the fewest licensed hospital beds of the seven developed countries, and we are considerably below the median data for all OECD reporting countries.

Similarly, U.S. physician availability is quite low as compared to our industrialized peers. France, Germany and Italy all have significantly more physicians per 1,000. Here again, the U.S. falls well below the median data for all OECD reporting countries.

Annual U.S. medical school graduate output is also quite modest, failing to keep pace with France, Germany, Japan and the UK. Again, we fall below the median for all reporting countries. This indicator may explain why the U.S. relies so heavily on the supply of international medical graduates, particularly for our primary care medical residency programs^5,10. It appears that in the aggregate, U.S. medical schools lack the capacity to graduate sufficient numbers of physicians to keep pace with the rising demands of normal population growth and the increasing needs of an aging America.

Overall, what these data suggest is that the U.S. medical delivery system may not have sufficient resources to be able to accommodate increased demand from newly insured patients. In economic terms, we could consider certain aspects of the medical delivery system as “resource-constrained.”

From a cost perspective, these constraints are likely to create further problems. In general, when supply is not able to increase to accommodate increased demand, prices increase, not decrease. In this scenario, one would expect higher prices, longer wait times for services or both⁶.

Now, we turn to the law’s implicit assumption that U.S. patients consume too many medical services and that wasteful spending must be the result. Again, the comparative data do not appear to support this hypothesis.

In terms of utilization of hospital inpatient services, the U.S. exhibits very conservative usage of these expensive resources. Of the seven developed nations, only Canada uses hospital inpatient services at a rate lower than the U.S. In fact, length of stays for U.S. patients is the lowest of the seven industrialized nations and among the lowest of all OECD reporting countries. It appears that Americans are not eager to be hospitalized and, once admitted, quite anxious to leave, at least in comparative terms.

Similarly, U.S. patients tend to be most conservative in terms of seeing their physician. Here, the U.S. has the lowest physician consultation utilization among our seven-country cohort and is well below the median for all reporting OECD countries (3.8 annual visits per year versus the 6.3 median for all countries).

While not shown in our data, it is true that the U.S. does make use of more outpatient hospital services than many other OECD reporting countries. What is equally true is that as this shift from inpatient to outpatient care has occurred, total medical care costs have increased rather than decreased. This is thought to be largely a result of cost-shifting practices among U.S. hospitals¹.

The next step: How did we get here, and where do we go now?

However surprising these comparative data are, they are far from conclusive. What does seem warranted is a closer look at our assumptions about the U.S. medical delivery system and about our citizens as consumers of health care. Working from faulty premises may have us addressing the wrong issues and trying to solve the wrong problems.

In our next installment, we will discover that the resource constraints that I refer to are not a recent development. In fact, some policy experts have been writing about this issue for some time². The situation has been building for many years and, in some cases, are logical outcomes of deliberate policy decisions made over the course of decades⁹.

Moreover, there is recent evidence to suggest that medical resource constraints are escalating, resulting in such things as primary care physicians using emergency rooms to deal with patient volume that they cannot accommodate^{3, 11}.

It seems that we may have arrived exactly where we have been headed.

References

1. Accounting for the cost ofhealth care: a new look at whyAmericans spend more (2008).McKinsey Global Institute. LosAngeles, CA.
2. Anderson, G.F.; Reinhardt,U.E.; Hussey, P.S.; Petrosyan,V. (2003). It’s the prices, stupid:Why the United States is sodifferent from other countries.Health Affairs, 22(3), 89-105.
3. Emergency visits are increasing,new ACEP poll finds; manypatients referred by primary caredoctors (2011). PR Newswire U.S.
4. Health care productivity(2006). McKinsey Global Institute.Los Angeles, CA.
5. Koehn, Nerrissa, M.D.; FryerJr., George E., Ph.D.; Phillips,Robert L., M.D., M.P.H.; Miller,John B., M.D., M.P.H.; Green,Larry A., M.D. (2002). Theincrease in international medicalgraduates in family practiceresidency programs. FamilyMedicine, 4(6): 429-35.
6. Mankiw, N.G. (2007).Principles of microeconomics (Fourth Ed.). Toronto, Ontario:Thompson.
7. OECD frequently requestedhealth data (2010). Organizationfor Economic Cooperation andDevelopment. www.ecosante.org/oecd.htm.
8. Reinhardt, U.E.; Hussey, P.S.;Anderson, G.F. (2004). U.S.health care spending in an internationalcontext. Health Affairs,23(3), 10-25.
9. Sagness, Janelle (2007). Certificateof Need Laws: Analysis andRecommendations for the Commissionon Rationalizing NewJersey’s Health Care Resources.State of New Jersey.
10. Sohi, Sajeet (2011). Internationalmedical graduates: apossible solution to the expectedphysician shortage. https://www.eyedrd/2011/05/internationalmedical-graduates-a-possiblesolution-to-the-expectedphysician-shortage.html.
11. Tobler, L. (2010). A primaryproblem: More patientsunder federal health reform withfewer primary care doctors spelltrouble. State Legislatures, 36(10),20-24.

I found Ethiopians to be a kind and generous group with an amazing sense of pride in their culture and heritage. The nation claims to be the birthplace of coffee, and the people have traditional coffee ceremonies in their homes. When you are offered coffee, it is very rude to decline.

Although Ethiopia is considered one of the most progressive African countries in medical care, standards are not congruent with what is found in an American operating room. With frequent power outages and the overall lack of resources, it was a real exercise in creativity. We had to learn to do the very best with what was available.

The nurses taught me nearly 50 alternative uses for IV tubing. Truly amazing! Power outages often left us using cell phones as light sources for the surgeons. There indeed is never a dull moment abroad.

Duringmy stay, Idevoted themajority ofmy effortsteaching Ethiopiannurseanesthetiststo perform regional nerve blockades.More commonly knownas a nerve block, this techniqueinvolves local anesthetic injectedaround nerves for the temporarycontrol of pain. Used in the U.S.extensively for years, this was anovel technique for the studentsand represented a large step forwardin anesthetic management.

Due to limited operating room availability, many simple procedures were not being completed. Introducing regional nerve blocks meant the patient no longer needed to undergo general anesthesia. This allowed the surgeon to perform the surgery without a formal operating room. We started completing the procedures in the hallways and making procedure rooms out of what were once closets.

Interestingly, the Ethiopian calendar currently reads August 2003. However, their medical acumen is far more than seven and a half years behind that of the U.S. Leprosy and polio are still prevalent, and salaries are very low. Most of the nurses I instructed had jobs after we were done training in the operating room. They would work overnight at private clinics to handle emergencies. Their salary would be 200 birr for this effort, which is roughly $12. In the United States, the same shift would pay more than 100 times that. Without funds to increase the education of the medical professionals in the country or provide better accommodations for patients, an increase in the quality of patient care is not likely to be immediately forthcoming.

After completing my month-long stay in Ethiopia, I returned to the U.S. with a renewed sense of professional commitment and appreciation for the tremendous opportunities available to help those less fortunate. I have lived a very lucky life. I was born into an amazing family in the right geographical location and time. I have had opportunities that are absolutely uncommon to those outside the developed world. One way to show this appreciation is through giving back, and strangely the rewards are far greater than you give. That’s why I encourage others to also share whatever training, resources or time they can for causes both foreign and domestic. I hope the inspirational nature of my journey will compel others to find a cause they feel strongly about and do their best to improve the lives of others.

Karl Disque, D.O.’07, R.Ph., became interested in international medicine after the January 2010 earthquake devastated Haiti. A senior anesthesia resident at Rush University Medical Center in Chicago, last year he spent 10 days in Port-Au-Prince, Haiti, as part of 20-member Rush medical team that treated up to 1,000 patients a day in hospitals, refugee camps and makeshift clinics. With one month left of his residency, he decided to again take his skills across the globe to help people desperately in need of more effective medical care. You can contact Disque at fritzdisque@gmail.com for additional information on volunteer opportunities or with questions about his experiences.

I was on a trip organized by the late Dr. Steve DeVore to Mali, Africa, through his nonprofit group Medicine for Mali. I returned to the States and my medical rotations with a changed outlook on medicine. I pursued an orthopedic residency of which I am now in my third year. I vowed to continue to serve the underserved in whatever medical capacity I was able, and this past March the opportunity to participate in another trip with Des Moines University arose. My wife, Tami, and I (shown in the photo) jumped at the opportunity.

Twenty-eight medical students, three physicians and a physical therapist partnered with the international nonprofit group Global Brigades and traveled to Tegucigalpa, Honduras, March 19-25. In just four days our group, with the assistance of two Honduran doctors, a dentist and a pharmacist, treated more than 1,000 patients in rural communities some two to three hours’ drive from the city. Most of these patients did not have routine access to medical care and were suffering from an array of common (and a few uncommon) ailments. The medical students took turns translating, triaging patients, taking vitals and examining patients with the physicians.

I’ll have to admit, as excited as I was to have the opportunity to participate in another global health trip, I was a bit nervous. After all, I am an orthopedic surgery resident. Probably much to my former DMU physical exam instructor’s chagrin, I haven’t picked up an otoscope or ophthalmoscope in several years! But Dr. Roberta Wattleworth had taught me well, and in no time we were diagnosing acute otitis media and cataracts without missing a step. We even witnessed a case of Bell’s palsy.

We saw newborns to octogenarians. There were, of course, the slew of common musculoskeletal complaints we had expected, and I had come well prepared with a full suitcase of supplies donated by my hospital back in Lansing, Michigan. There were a few budding orthopedists in our group who didn’t hesitate at the opportunity to learn how to inject a knee or shoulder. The tropical dermatology book was opened frequently, hundreds of teeth were pulled, many Pap smears were performed and through all our encounters there was a common theme: joy and gratitude. No matter the symptom, no matter the treatment rendered, the patients we gave care to truly appreciated the fact we were there to serve. Waiting three hours to be seen – no problem!

Walking five hours in the heat and dust – no problem! Words can’t describe the sincerity expressed by the patients we saw. I witnessed this sincerity of gratitude as a student in Africa and now again as a physician in Honduras. The attitude these patients expressed is why I gave up my vacation to serve.

The DMU students on the trip were phenomenal. Their attitudes and abilities truly speak to the preparedness the University bestows upon them. I can also say the same for my own training. I was given the opportunity as a medical student to participate in a global health trip, and I was taught the basic osteopathic skills and philosophies that would allow me to give back to the general medical community as a proud Des Moines University alum. I’m already looking forward to the next opportunity!

Joel Post, D.O.’08, resides in Lansing, MI. DMU’s partnership on this trip with Global Brigades came about thanks to Hiral Patel, D.O.’14; as an undergraduate at the University of California-Berkeley, she went on that university’s first Global Brigades trip to Honduras, helped organize another one and has since spent about two years in the country, where she’s helped develop a sustainable community health program.

Associate professor and clinical outcomes coordinator for DMU’s physician assistant program, Pam Harrison Chambers was one of the founding members of the College of Health Sciences Alumni Board of Directors in 2005. She has continued to serve on the board and is a two-term board president. Chambers volunteers her time with DMU student activities, the Leukemia and Lymphoma Society’s Patient Services Committee, Southeast Polk High School, the Pre-PA Club at Iowa State University, Polk County 4-H and the Central Application Service for Physician Assistant Program Advisory Committee for the Physician Assistant Education Association. She also serves on one of the PA national recertifying exam committees for the National Commission on Certification of Physician Assistants.Laura Delaney, PA-C, M.P.A.S., an instructor in the PA program, describes Chambers as a great teacher, mentor and friend whose commitment to DMU, the PA profession and education “is an understatement.” “This prestigious honor and well-earned recognition as CHS Alumna of the Year is truly expressed by Pam Harrison Chambers day in and day out, because that is just who she is and what she does,” Delaney adds. Chambers attended Iowa State University and the Marshalltown Community College School of Nursing. She was also a member of the first graduating class of DMU’s master of public health program.

College of Osteopathic Medicine Alumnus of the Year
Charles A. Finch, D.O.’94, FACOEP

A partner with Scottsdale Emergency Associates in Arizona, Charles “Chip” Finch serves on the board of directors of Stepping Stones of Hope, a nonprofit organization that provides comprehensive support-based programs to grieving children, families, adults and communities. He is founder and director of Camp Paz, a Stepping Stones program that helps grieving adults and children heal together. Finch is past president and current member of the Arizona Osteopathic Medical Association Board. He is past president of the DMU College of Osteopathic Medicine Alumni Association Board of Directors and of the American Lung Association of Arizona. He is also the medical director for the Salt River Fire Department. Finch is an associate clinical professor of emergency medicine and chair of the integrative medicine department at Midwestern University-Arizona College of Osteopathic Medicine. Finch is known for helping others on a personal level. Last year, as a DMU alumni mentor, he helped open a job interview at his practice for DMU physician assistant program graduate Dan Deublin, who was hired there. He continues to consider Finch a mentor and role model. “To describe how much respect and admiration I have for Dr. Finch would simply cause me to run out of language,” Deublin says. A graduate of Arizona State University and DMU, Finch trained in emergency medicine and trauma at Maricopa Medical Center.

College of Podiatric Medicine & Surgery Alumnus of the Year
William Hal Hatchett, D.P.M.’00

A member of the DMU Board of Trustees since 2005, William Hal Hatchett is a board certified podiatric surgeon with Coastal Carolina Podiatry in Summerville, SC. As a CPMS student, Hatchett broke barriers, becoming the first CPMS student to serve as the president of the Student Government Association. He also chaired a committee responsible for creating the student honor code still in effect at the University. As an alumnus, Hatchett co-chaired the CPMS Alumni Board of Directors before becoming the first CPMS graduate to join the DMU Board of Trustees. He often takes DMU students on rotation, too. “Hal has been very dedicated to DMU in each of his levels of endeavor – student, podiatric physician and University trustee,” says James Grekin, D.O.’62, MACOI, a retired physician and chair of the DMU Board of Trustees. Hatchett earned his B.S. degree in ergonomic engineering from the U.S. Military Academy at West Point. Early in 1991, months after Iraq invaded Kuwait, he deployed in one of the first U.S. military units in Operation Desert Storm. He served 10 months in Kuwait, Iraq and Saudi Arabia. He has been a triathlete for several years, often participating in events that raise funds for charities. After graduating from DMU, Hatchett completed his residency program in foot, ankle and lower leg surgery at Western Pennsylvania Hospital in Pittsburgh.

Jose Figueroa, D.O. '95

The president, president-elect and vice president of the Iowa Osteopathic Medical Association (IOMA), elected at the organization’s 113th annual conference this spring, are DMU graduates. IOMA also selected a DMU graduate and faculty member as its 2011 Physician of the Year.

Elected president was Timothy Piearson, D.O.’02; president-elect, Conway Chin, D.O.’92; and vice president, Tamara Chance, D.O.’95.

Piearson, who is board-certified by the American Board of Osteopathic Family Physicians, is in private practice at the Adair County Medical Clinic in Greenfield.

Chin is board-certified by the American Board of Physical Medicine and Rehabilitation and the American Osteopathic Board of Physical Medicine and Rehabilitation. He is medical director of rehabilitation services at Genesis Medical Center in Davenport.

Chance, who is board certified by the American Osteopathic Board of Family Physicians, is on staff and is the medical director of the emergency departmentat Boone County Hospital. She is also a staff ED for Physician Healthcare Services Emergency Physicians and an adjunct faculty member at DMU.

Named IOMA Physician of the Year was Jose Figueroa, D.O.’95, DMU assistant professor in osteopathic manual medicine, staff physiatrist and OMM clinician. Board-certified by the American Osteopathic Board of Rehabilitation Medicine, the American Board of Physical Medicine and Rehabilitation and the American Board of Neuromusculoskeletal Medicine, Figueroa is a diplomat of AOBPM&R and a fellow of the American Academy of Physical Medicine and Rehabilitation. He also served as a major in the U.S. Army.

The Iowa Osteopathic Medical Association, founded in 1898 and headquartered in Des Moines, represents the approximately 1,000 osteopathic physicians practicing in Iowa.

In the next 10 to 15 years, the loss of health and life in every region of the world, including Africa, will be greater from noncommunicable or chronic diseases, such as heart disease, cancer and diabetes, than from infectious and parasitic diseases.

Global aging is a success story. People today are living longer and generally healthier lives. This represents the triumph of public health, medical advancement and economic development over disease and injury, which have constrained human life expectancy for thousands of years. It also brings challenges: health care challenges, city planning challenges, nutritional challenges and economic challenges, to name a few.

As people live longer and have fewer children, family structures are transformed. This has important implications in terms of providing care to older people. Traditionally, the old-age dependency ratio, OADR (the number of people aged over 65 to people of working age), was used to assess the burden to society of supporting elderly people. A new dependency measure is called adult disability dependency ratio, or ADDR. It is based on disabilities that reflect the relationship between those who need care and those who are capable of giving it. Either way, we don’t have enough working, capable people to take care of our fast-growing centenarians.

Traditionally, elderly people were accorded a great deal of respect, and they exercised considerable authority in domestic and community affairs. Our rapidly changing global society has reduced the role of the elderly, but not their need for a safe and secure environment.

What society can do represents a daunting to-do list, to be sure. Yet we must continue, increase or begin these actions in order to manage the inevitable transitions our aging population will force. As communities, professions, states and nations, we need to engineer solutions in areas ranging from workforce productivity and immigration policy to pension plans and health care delivery.

One opportunity to begin these discussions is the third annual global health conference, sponsored by the Heartland Global Health Consortium, of which DMU is a member, and Pioneer. Held on our campus on Oct. 12, the conference will engage experts and audience members in discussions on the challenges of global aging and the actions we must undertake now to deal with them. Such discussions and actions are critical: Amid all the challenges of our world, few are as certain, and potentially profound, as the gray tsunami.

What can you do as an individual?

• Develop behavior to optimize yourhealth
• Maximize your potential for physical,social and mental well-beingthroughout the life course
• Stay connected to people throughan active social life

What can society do?

• Promote healthy lifestyles forelderly people
• Facilitate easy access for the elderlyto health screenings and healthservices
• Develop culturally appropriatesocial and recreational programs
• Provide transportation
• Continue programs that supportfinancial security
• Make cities age-friendly

Triple-board-certified in family medicine, geriatrics and hospiceand palliative care, Yogesh Shah, M.D., is associate dean of globalhealth and director of the Memory Clinic at Des Moines University.

“Hon. A.L. Conger, of Ohio – a man of National reputation, a Union soldier of proved merit, and a citizen of general usefulness – is in Des Moines, with a desire to establish here a School of Osteopathy with departments for the treatment of afflictions by that most modern and successful method for the cure of the ills of humanity,” stated The Des Moines Register in an 1898 editorial.

The University is featuring displays in the DMU Library to mark the sesquicentennial of the beginning of the Civil War.

Information and images courtesy of DMU Archivist Lindsey MacAllister Smith, M.A., and the DMU archives.