Nurturing The Nurturers

Nellie is a young working mother of a one-year-old. She's been married for two years, a June bride just two weeks after graduation. Determined to be independent, Nellie talks tough when she's with her friends and acquaintances. She believes her marriage has liberated her - it is her equalizer with her parents. She and her husband are buying a house, own two cars and a truck, and are starting their own business.

But Nellie has a secret life too: she is a battered woman. Only recently, after arriving at work with serious injuries for the third time in six months, did she share her secret with a secretary. Nellie didn't fall down the stairs and break her arm, and she's not suffering from TMJ but from a broken jaw. The plain fact is that her husband is beating her.

Friends and family tell her to leave because her husband's behavior won't improve. But Nellie believes she must work it out. Besides, she argues, he truly loves her; he is so sorry after he hurts her. What would her leaving do to her husband? And, her son needs his dad.

Her friends don't have the answers. They wonder why Nellie's doctors and nurses don't do something. They are the experts; can't they see what's going on?

Thousands of women in Indiana are in abusive relationships, sometimes with an angry husband, other times related to alcohol or illegal drugs. Their friends and families don't know how to help them, and many times they are unaware of the problem. The resources in the community are nearly invisible, and often inaccessible to many women who need them. But there is an action under way to improve this situation for Nellie and the millions of women who are living with health dilemmas, whether caused by abuse or by other factors.

Most major illnesses among women are preventable. Lung cancer is the leading cause of cancer deaths among women, almost entirely attributable to smoking. Heart disease is the other leading cause of early death among women. It is attributed to poor diet and lack of exercise, but more notable is the fact that it is diagnosed and treated at a much lower rate than it is in men.

Based on the belief that changes in the country's health profile will begin with changes in how the health community and other service organizations approach women, the U.S. Department of Health and Human Services (HHS), Office of Women's Health has created eighteen Centers of Excellence (CoE) in Women's Health. Through its funding to the IU School of Medicine and seventeen other academic medical centers throughout the country, HHS intends to nurture an initiative to significantly improve women's health. To accomplish this, the eighteen centers are charged with developing networks among existing agencies that serve women, aiming to build critical mass through common goals.

The components of the CoE in Women's Health include clinical care, research, professional education, outreach and consumer education, and leadership mentoring for women. Rose S. Fife, MD, is director of the CoE in Women's Health at IUSM. Ann Zerr, MD, is co-director. Four other IUSM faculty members focus on each of the five components outlined by the HHS Office on Women's Health.

The Center of Excellence designation gives Dr. Fife and her colleagues a platform that attracts additional grants and collaboration from other state and local agencies. Their most recent success is obtaining a one-year, $56,000 grant from HHS. It will allow DaWana Stubbs, MD, a young general internist on the IUSM faculty, to initiate and manage an education and intervention program on domestic violence for adolescents seen at a Wishard Health Services Westside Health Clinic.

This initiative is the latest in a series of accomplishments by Dr. Fife and her colleagues since receiving the designation as a CoE in October 1997. Others include an undergraduate biology course that focuses on women's health, now taught by Florence Juillerat, PhD, through Women's Studies in the School of Liberal Arts at Indiana University Purdue University, Indianapolis. IUSM faculty members Lynda Means, MD, and Valerie Jackson, MD, lead a mentoring program that connects female faculty and medical students (see Indiana University Medicine, Winter 1998) to build an intergenerational network of female physicians and researchers.

Monthly programs about women's health are open to university faculty and staff in an effort to inform colleagues about research in women's health and to create an information exchange among people in research, education and patient care. As assistant dean of research at IUSM, Dr. Fife is active in developing research with a focus on women's health. Her personal interest is research on the role that tetracyclines might play as anti-angeogenic agents for the treatment of breast, prostate, ovarian and bone cancers. A Phase II study of tetracycline in women with breast cancer is likely to begin this year.

Most importantly, Dr. Fife and her colleagues are developing new programs to reach the community at large. Working with several other organizations, the IU CoE on Women's Health is planning a series of public presentations on women's health for the fall of 2000 to champion advances in women's health throughout the next century.

In The Works

DaWana Stubbs, MD, clinical assistant professor of medicine, initiated and manages an education and intervention program on domestic violence for adolescent men and women seen at the Wishard Health Services Westside Health Clinic. "We are focusing on the adolescent in this program because we want to intervene at a time that will prevent future abuse," she says. "We believe we can instill skills to prevent young adolescent women from becoming victims and young adolescent men from becoming abusers."