<By Mary Koziol 
With a carload full of snacks, our lectures downloaded for weekend catch-up and having triple-checked that we have our Canadian passports, the six of us are on the road for Boston. This was part 2 of the Harvard-McGill student exchange, facilitated by McGill alumnus and current Harvard professor Dr. Jeffrey Semaan, which took place from April 29 to May 1.
We arrive in Cambridge just past midnight, where our Airbnb host David is waiting for us. He leads us up two creaky flights of steps to our apartment, where we gratefully unload our belongings. “Ah McGill!” says David, “I’ve done a lecture or two there.” Turns out that David is a gifted researcher in the area of immunotherapy, and he proceeds to give us a brief talk on the role of caffeine and its potential in cancer treatment. We remark that our surprise crash course is a pretty cool experience to have with our Airbnb host. “It’s Cambridge,” he shrugs. Meaning? Good luck finding anyone who isn’t an academic.
The next morning we’re off to an early start. Dr. Semaan greets us with hugs and a smile, promptly guiding us to our first session at the Cambridge Health Alliance (CHA), a network of primary care and hospital sites throughout Cambridge that focuses on primary care, specialty care, and mental health/substance use resources. We make our way up to the second floor of one of the community sites, a cozy and welcoming room with plush sofas and exposed brick walls. We settle around the boardroom table and meet our first lecturer, Dr. David Bor for a talk entitled “CHA: A Public, Academic Community-Responsive Health Care System.” Dr. Bor served as chief of medicine of the CHA for 21 years and had overseen much of its expansion and development. His talk explores the history of the CHA, both an interesting survey of modern medicine as well as a helpful backgrounder on the state of public health care in Massachusetts. Turns out Massachusetts has a much stronger public health care system than many of us had previously known, somewhat ironically known as Romneycare (Mitt Romney was the governor at the time of the health care reform that led to provision of health insurance for most of Massachusetts’ residents).
Sooner than we would have liked (a busy day lies ahead) we have to thank Dr. Bor, and we’re on the road to the Albany Street Shelter where we meet with Mark McGovern, a social worker and program director of Healthcare for the Homeless, who tells us the “Tale of Addiction and Homelessness.” This shelter, also part of the CHA, is dedicated to active substance abusers and has a policy to ‘meet people where they are.’ After taking a few moments to orient us to their work, Mark brings in Tom*, a client of the shelter who has agreed to be interviewed by the McGill students so we can learn firsthand the daily realities of homelessness and substance abuse within the context of the American medical system.
Tom is a physically intimidating man with a deep, powerful voice. He talks to us about the beginnings of addictions (what he calls the “poor man’s speedball”, nicotine and caffeine), about his past as a successful athlete, about the resultant injuries that have made finding work very difficult, about how his addiction spiralled out of control when he found himself out of work, about the day to day challenges of heroin addiction and homelessness, and of his past successful rehabilitation and subsequent relapses. He treats us to a song at the very end, his soulful voice filling the room. On the last line “we fall down, but we get up” he stands, we thank him, and he exits the room. All of us struggle to find the words to convey the impact his story has had. Mark talks to us a bit more about the typical trajectory of addiction, and how relapses are, in most cases, inevitable. However, he notes, the sooner you can get someone to treatment, the longer the recovery period. Mark reads us a piece of prose he had recently shared publicly, entitled “The Life of a Homeless Man,” where he details the daily indignities, injustices, and hardships that are customary in the life of homeless persons, all of the examples drawn from his daily work in the shelter. We receive a quick tour of the shelter and then it’s time to go. We emerge, blinking a bit dazedly in the bright sun, trying to absorb the immensity of the experience we’ve just had.
We head back to the CHA community site where Dr. Shonkoff is waiting for us to discuss “Leveraging Science to Strengthen the Early Childhood Foundations of Lifelong Learning, Behaviour and Health,” He begins by saying, “Call me Jack”—and then, “after I give you this talk, I need you to go and cause trouble and change things, so that I’m not wasting my time.” A provocative start to a stimulating and energizing talk; his team’s research is looking at how childhood adversity, what they have coined ‘toxic shock,’ is biologically embedded. Essentially, the constant activation of the stress system during childhood, and even pre-natally, leads to long-term disruptions in brain architecture, immune status, metabolic system, cardiovascular function, and gene expression. Specifically, there are particularly important development windows where toxic stress has an especially devastating effect. The takeaways? Early childhood adversity affects lifelong health, not just lifelong learning; healthy development requires protection, not just enrichment in the school setting; and achieving better outcomes for children requires support for the adults who care for them. The most important thing we can do to prevent toxic stress and its lifelong repercussions is to build capacity within the family; he emphasizes the need to get away from ‘parental training’ as a model and to move toward intensive coaching to help parents build skills and have control over their own lives. And to his point about causing trouble and changing things? He says we need to stop going out and doing the same things that people have been doing for over 100 years that simply don’t work. This requires an environment that has never existed before: we are afraid to take risks, we do not learn from our mistakes, we fail to do honest evaluations of the outcomes. The solution is going to require a portfolio of interventions based on what works best and for whom. On that thought-provoking note we end, thank him, and pile back into Dr. Semaan’s van to our second to last lecture of the day.
This trip brings us to the Zinberg Clinic, a dedicated care center that uses a multidisciplinary approach to care for patients living with HIV, viral hepatitis, and other sexually transmitted infections. Dr. Coste shows us around the clinic and leads us to a conference room downstairs to talk about “Responding to the HIV Epidemic in our Community.” He begins with a timeline of the HIV epidemic, explaining the role of the Zinberg Clinic in trying to address the crisis, and the many difficulties of providing care for such a deeply stigmatized illness. A key strategy the clinic uses, even now, is to draw people in by meeting their needs: the Clinic’s food pantry is often the most important point of entry for many of their patients. Dr. Coste also speaks about the challenges of screening for HIV in the community, zeroing in on the communication barriers that we, as health care professionals, often propagate with our own discomfort. “Ironically,” he says, “it may require greater intimacy to discuss sex than to engage in it.”
Our final lecture of the day takes place at the Massachusetts General Hospital in the historic Ether Dome, a surgical operating amphitheatre that had served as the hospital’s OR between 1821-1867. It’s surreal to enter the Ether Dome, a strong contrast with the modern day OR. The high dome ceiling has windows that bathe the room in natural sunlight, and the room is mostly occupied by steep rows of seating for ticket-bearing surgical spectators of the time; I immediately recognize the ceiling high painting that adorns the front wall from my anesthesia textbook, a depiction of the first public demonstration of anesthesia (ether) for surgery. We are fortunate to receive a lecture from current anesthesiologist Dr. Vassallo on “Bulfinch’s Ether Dome: Its Place in Anesthesia History.” Dr Vassallo details the experiments and discoveries leading up to the use of ether, as well as the cast of characters involved, making for quite an interesting story behind this celebrated landmark.
At last, it’s time to bid farewell to Dr. Semaan. He brings us to Harvard Medical School to be greeted by our student hosts. It’s a happy reunion for all. We spend the weekend dining at their favourite haunts and hanging out in their medical student dormitory, where the vast majority of students live. We receive a tour of the Harvard campus and the Harvard art museum as part of the University’s ‘ARTS FIRST’ festival weekend, and end the day on Saturday by sailing along the Charles River, chatting in French with our Canadian-born sailboat operator. On Sunday, we have enough time to traverse the Freedom Trail, winding our way through downtown Boston to take in notable monuments from US history, before we hug our hosts goodbye, reminding them they always have a place to stay whenever they come back to Montreal.
On the ride home, we are a lot quieter than on the drive down. We are all absorbing the weekend, trying to process the many layers of the experience, running through our favourite memories, considering all of the new questions elicited, trying to make sense of the complexity of US health care. Only 6 hours away by car, there is not a lot of physical distance separating Harvard from McGill, yet on close examination the rich historical, cultural, political, and geographical roots of the institutions and surrounding communities account for two very distinct education experiences with so much to learn from one another. It only took one person in the form of a McGill alumnus to help us build that connection, to plant the seed for an ongoing exchange of knowledge and ideas that deeply benefits us all.
*identifying features have been changed to protect privacy.
June 10, 2016