UNM doctors, nurses and techs put their lives on the line in the worst health care crisis in a century – when patients had no one else to turn to. These pictures tell the story of their courage and commitment.
The first shipment of the Pfizer vaccine arrives at UNMH.
The COVID vaccine being administered at ‘The Pit’ sports arena in Albuquerque.
Lifeguard Flight Nurse Verena Weissenborn helps a member of the public get her COVID vaccination.
Lifeguard transports in 2020
More than 300 COVID-related transports.
UNM Health began vaccinating frontline workers who had direct contact with COVID-positive patients in mid-December 2020.
From there, efforts expanded to include a mass vaccination center at The Pit, UNM's sports arena, and vaccination clinics in Sandoval County.
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UNM Health began vaccinating frontline workers who had direct contact with COVID-positive patients in mid-December 2020.
From there, efforts expanded to include a mass vaccination center at The Pit, UNM's sports arena, and vaccination clinics in Sandoval County.
Utilizing the New Mexico Department of Health's vaccination registration site, UNM Health was able to quickly and efficiently notify eligible community members of open appointments to be vaccinated. The Pit is currently averaging about 1,600 doses a day, but plans are in place to expand operations to up to 3,600 vaccinations a day.
UNM Health has played a major role in helping New Mexico become No. 1 in the nation for the percentage of its population having received at least one vaccine dose.
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| December 15-31 | 7,192 |
| January 1-27 | 20,809 |
| January 28-February 24 | 13,404 |
| February 25-March 23 | 21,578 |
| Total | 62,983 |
Breakdown of how many doses of the COVID-19 vaccine have been administered by UNM Health since receiving the first shipment of vaccines in December 2020.
For much of 2020 UNM Hospital was hardly recognizable – not because it looked any different physically but because, for much of the year visitors were no longer allowed due to the SARS-CoV-2 pandemic.
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For much of 2020 UNM Hospital was hardly recognizable – not because it looked any different physically but because, for much of the year visitors were no longer allowed due to the SARS-CoV-2 pandemic.
The visitor policy was restricted in order to reduce the number of people in the hospital, but frontline workers, including clinical staff and providers remained on-site, caring for New Mexicans. Most non-clinical staff either worked remotely full-time or followed a hybrid schedule, rotating between their homes and offices.
In non-COVID times, members of the Interpreter Language Services (ILS) team are busy fielding in-person interpreter requests from throughout the UNM Health System. Their offices were filled with team members handling phone calls, making video appointments and translating documents.
But with the pandemic restrictions the department office was almost empty, and only a few staff were on hand each day to assist hospitalized patients. But the quiet office was deceptive: requests for the ILS team’s services did not decrease due to COVID-19.
“Like many across the UNM Health System, our team is adapting our service model. Not only are we meeting the needs of our patients but also the needs of patients across the country,” says Fabian Armijo, director of Interpreter Language Services and Diversity, Equity and Inclusion at UNMH.
“Although during the pandemic the majority of our services are not in-person, we are still interpreting for patients through video and phone, along with providing translation services for hundreds of urgent internal documents, communications and signage.”
Some of the exceptions that warrant in-person services include patients who are being seen in the Emergency Department, end-of-life conferences and deaf/blind patient visits, Armijo explains.
Millie Smith, a Spanish medical interpreter/translator who joined the ILS team more than five years ago, was part of the frontline efforts to ensure effective communication between patients speaking a language other than English and providers during the pandemic.
“Since we cannot do in-person interpretations, sometimes it is very challenging to do video and phone interpretations when most of the COVID-19 patients are in specially equipped rooms where the noise level is higher than normal,” Smith says. “A positive experience is that since family members cannot visit their loved ones due to COVID-19 restrictions, they can still be part of the patient care or treatment by the use of phone or video interpreters.”
Along with being the most robust in-house health care interpreting team in New Mexico, UNMH is a member of the Health Care Interpreter Network (HCIN), the nation’s only coast-to-coast network of hospital-based video interpretation. HCIN member hospitals share interpreters through a video network that ensures patients receive care in the language they understand.
The UNMH ILS team has been interpreting for COVID-19 patients and health care providers across the country, including Kaiser Permanente Los Angeles Medical Center, Parkland Hospital in Dallas and Cambridge Health Alliance in Boston.
Melissa Salazar, a certified health care Spanish interpreter, started at UNMH 18 years ago. She volunteered to be one of the in-person interpreters for the Emergency Department, which she described as both challenging and rewarding at the same time.
“The challenge for me was not going into suspected COVID or COVID-positive rooms – it was frustrating to see folks feeling alone and isolated, having minimum contact and struggling to understand and be understood,” Salazar says.
She’s proud that the ILS team never stopped providing services to UNMH patients and to patients across the country. Although ED services are mostly available in person, ILS department leadership keeps safety at the forefront by scheduling more video shifts, increasing telephonic work and creating opportunity for staff to work remotely.
ILS has come a long way since becoming an official department in the late 1990s, when it was staffed with only five interpreters for Spanish, Vietnamese and Navajo languages. Over the years, the team has grown to more than 30 interpreters and translators. They still provide services in Spanish, Vietnamese and Navajo, but the department more recently added American Sign Language (ASL).
Certified ASL interpreter Cara Balestrieri was one of two ASL interpreters hired in 2017 due to the increased requests for services. In addition to some of the existing health care barriers someone who is deaf or hard of hearing, COVID creates additional communication issues, Balestrieri explained.
“Sign language uses mouth movements, body movements and facial cues for grammar,” Balestrieri says. “Masks and eye shields make it hard for patients to see my face, and it’s also challenging for me to see my patients’ faces. It’s also difficult for deaf patients to be hospitalized for long periods of time without visitors.”
Along with Salazar, Balestrieri fields requests via the HCIN when she is able and witnessed firsthand some of the similar struggles hospitals are facing across the nation. As in New Mexico, many states are dealing with multiple demands, like environmental disasters and public protests, which in turn can pose additional health care challenges, she says.
“They are struggling with protests, which can cause injuries,” Balestrieri says. “I also have seen the isolation and loneliness of deaf patients hospitalized in other states. Patients also tell me about the lack of interpreter services in states that are experiencing natural disasters and social unrest.”
Although COVID-19 is complicated, scary and compounds existing health care barriers, Balestrieri and her colleagues continue onward, encouraging patients and reminding them of the pandemic’s new mantra: “We are not alone.”
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When the COVID-19 pandemic began, many universities had to find ways to educate students remotely – including The University of New Mexico College of Nursing.
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When the COVID-19 pandemic began, many universities had to find ways to educate students remotely – including The University of New Mexico College of Nursing.
“With COVID, our world turned upside down,” says Kathy Grand, MSN-Ed, RN. “We ended up trying to scramble and figure out how we would give them some form of experience with patient care.”
Prior to the pandemic, students followed a busy schedule says Grand, a senior lecturer in the College of Nursing. They had up to 96 hours of clinical work on top of classes and lab, but that changed once COVID-19 hit.
“You never thought about going to class, being around all your peers, interacting with your teachers on a daily basis,” says Adam Karig, a Level 4 nursing student. “You never really worried about what we have to do now.”
Grand and her colleagues searched for ways to give their students some clinical experience as the pandemic surged. Luckily, they had an idea: virtual simulation software called The Point.
“It’s kind of like a video game,” Karig says. “It allows you to be a virtual nurse and interact with and take care of a patient in different scenarios.”
Students use their computers to control what the virtual nurse says and does, view medical information about the virtual patient and reflect on how they felt about the simulation afterwards. The software also allows students to choose from 10 different scenarios in various disciplines.
“You can choose from a patient who has a hypoglycemic episode or a fracture that’s hemorrhaging out,” Grand says.
Karig likes that he can interact with patients that he might not normally get to see – like a psychiatric patient – using the software. “It gives you a perspective into what these patients are like in different kinds of scenarios,” he says.
Grand agrees that this is one of the software’s best features. The students should become more confident in the clinic after using the virtual simulation to participate in and practice how to respond to more advanced situations, such as a coding infant, she says.
Grand says that having the students repeat scenarios multiple times also helps them remember what is needed for a diagnosis, no matter the underlying cause. Karig agrees. “It helps to solidify the nursing process, so that definitely translates into real-life settings,” he says. “It helps you think about how to approach and care for these patients.”
Karig also appreciates that he is free to take his time, think through a scenario without a lot of pressure and try different things with the software. “It gives you more autonomy than you would actually get as a student nurse,” he says.
The software’s biggest limitations have to do with initially learning how to control the software and the student’s inability to deviate from scripted responses and actions, he says. “Sometimes, there might be something that I wish I could do, and in real life that I would probably do, but the program might not let you do that,” Karig says.
Though Grand knows that The Point – like any program – is not perfect, she thinks that building around it with post-simulation conferences and lab work has enhanced students’ skills since their return to the clinic. “I think students learned a lot more than I expected them to, which was very exciting,” she says.
Grand is also happy the with students’ responses to the program. “I know students prefer the clinical setting, but I have heard from many students that they’re glad they had the opportunity to do virtual simulation, and they learned a lot,” she says.
A few years back, Douglas Ziedonis collaborated with a percussionist friend to record The Journey, a collection of hauntingly atmospheric pieces performed on traditional Native American, Latvian and African wind and string instruments.
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A few years back, Douglas Ziedonis collaborated with a percussionist friend to record The Journey, a collection of hauntingly atmospheric pieces performed on traditional Native American, Latvian and African wind and string instruments.
The album’s title aptly describes the career path of a son of Latvian immigrants who would go on to become a prominent addictions psychiatrist, researcher and administrator – and now Executive Vice President for Health Sciences at The University of New Mexico and CEO of the UNM Health System.
Ziedonis, who assumed his new roles on December 1, brings eclectic interests and decades of experience in academic medicine. He has lost no time in getting to know his new colleagues and mastering the minutiae that come with the job.
“I feel like I’ve been here months, rather than days,” he says in an interview just before the winter holidays. He has been appraising Health Sciences colleges and programs, looking for opportunities to expand or forge new partnerships.
“There’s a really great group of leaders that I get to work with in Health Sciences and on Main Campus,” he says. “It has been in the middle of the acceleration of the pandemic, which has been the most challenging moment in my career. I feel strong pride for our terrific workforce here, who are on the front lines.”
Ziedonis, who most recently served as Associate Vice Chancellor for Health Sciences at the University of California, San Diego, has also been on faculty at Yale, Rutgers and the University of Massachusetts. He and his wife, Patrice, have crisscrossed the country since meeting while he was doing his psychiatric residency in California.
Now, they’re happily renting a house in the High Desert development in the Sandia Mountain foothills and enjoying New Mexico’s unique climate. “We love the idea that it can snow in the morning and with the sun it goes away,” he says.
Ziedonis grew up in Bethlehem, Pa., where his father, who emigrated from his native Latvia following World War II, was a Lutheran minister and a college professor.
After graduating Davidson College in North Carolina, Ziedonis attended medical school at Penn State with the thought of becoming a family doctor, but he changed course after a friend urged him to apply for a grant from the National Institutes of Health for a study measuring cerebral blood flow in sheep. Ziedonis was bitten by the research bug and found a growing interest in the functioning of the brain.
In 1985 he moved to UCLA for a residency in general psychiatry, joining colleagues who were conducting cutting edge research in cocaine addiction using positron emission tomography (PET) to image changes in the brain. In the lab next door, another team was using PET scans to study talk treatments for obsessive-compulsive disorder. “This was a game-changer for me, because it was the first study showing that the brain changes with psychotherapy,” he says.
Ziedonis completed an addiction psychiatry fellowship at UCLA, then moved to Yale in 1990 as an assistant professor, where he had his hands full.
“I was the medical director for a methadone clinic that had 750 patients,” he says. “Forty-five percent of them were HIV-positive, and we had no solution for them at that time. I had a hundred patients that were pregnant. God brings you things you’re not expecting.”
Meanwhile, he was also developing a program to treat people with co-occurring mental illness and substance abuse diagnoses. “I had 350 additional patients that were in an outpatient medication-free clinic,” he says. “I also ran an evening intensive outpatient program with patients. I did consults, and I had my own little outpatient clinic. So I was extremely busy clinically.”
Ziedonis managed to find time along the way to complete his master’s in public health. “That was the game-changer for me in becoming a serious physician-scientist with the ability to have independent funding,” he says.
In 1998 he moved to Rutgers University, where he expanded his interests to encompass treating tobacco addiction, working with Dr. John Slade, an acclaimed researcher and tobacco industry nemesis.
Ziedonis has nurtured a lifelong interest in mindfulness and spirituality that has helped shape his priorities as a researcher, clinician and administrator. “I was taught to pray early in life, and I remember very young, that was something that was important,” he says.
In college, he studied Chinese philosophy and Buddhism and practiced Transcendental Meditation. A few years later he became acquainted with the work of Jon Kabat-Zinn, a molecular biologist at the University of Massachusetts who melded elements of Zen meditation and yoga into a secular therapeutic modality known as Mindfulness-Based Stress Reduction (MBSR).
“When I was at UCLA in the 80s, I started to integrate some mindfulness into my clinical practice,” Ziedonis says. While at Rutgers, he also served as a visiting professor at the Princeton Theological Seminary. “For me, spirituality also aligns with diversity, because we’re of different faiths,” he says. “Understanding someone’s background and what matters to them – what are some of their core beliefs and values – that’s an important window, even if you aren’t coming at it from a faith-based point of view.”
Ziedonis joined the UMass faculty as tenured professor in 2007 and got to work firsthand with Kabat-Zinn and his Stress Reduction Clinic. “They weren’t used to a psychiatrist being open to that,” he says. “In my department we integrated it into all our teaching, research and clinical work. Then I got really well-grounded in MBSR and mindfulness-based cognitive therapy.”
While at UMass he also ran a mindful physician leadership program, and when he moved on to UCSD in 2017 he brought the mindfulness-based leadership training with him. “It’s now a course in the medical school for the students,” he says.
Ziedonis also agreed to serve as executive director of UCSD’s Center for Mindfulness, in addition to his other duties. When the pandemic forced the shutdown of campuses across the country, he helped create an online resource where people could come together to meditate virtually three to five times a day, as well as a collection of recordings they could access any time. “We’d get about 200-plus people a day, and we would get over a thousand people a day with the recordings,” he says.
“The blending of mindfulness and self-compassion work are really some important skills for clinicians,” he adds. “Doctors are really tough on themselves. They expect themselves to be perfect, and they have a really high bar. So, learning ways to just be OK with yourself – the shared common humanity, having some kindness to yourself.”
When it comes to his serious hobby of collecting and playing traditional musical instruments, Ziedonis calls himself “a closeted musicologist.” He performs on a Latvian woodwind instrument called a stabule and the kokle, a stringed zither. He has played African instruments, including the djembe, balafon and kora, and he has an extensive collection of Native American flutes made by Navajo and Jemez Pueblo craftsmen, among others.
“I like to learn about music and culture of different groups,” he says. “Throughout my career, I’ve taken a Native American flute on my travels.” On a research trip to Crete, he and his wife decided to visit a music shop to sample traditional Greek instruments. “Suddenly, we’re in some back alley, and nobody knows English, and I don’t know Greek – and she’s like, ‘How did we get here?’”
Ziedonis pulled out his flute and started jamming with the local musicians. “For me, those are some fun things about traveling,” he says. “I think of music as a language of communication. When you don’t have the other language, you can have that.”
The couple’s son, Mason, lives in New York City, where he works for Goldman Sachs. Their daughter Michelle, who has a master’s degree in dietetics, spent part of 2020 working at a Los Angeles VA medical center that was filled with COVID patients. “We can appreciate the front lines and all the pressures on families where they have to deal with that,” Ziedonis says.
Still, he knows the pandemic won’t last forever. “The spiritual side, the meditative side of me just loves being in New Mexico and is looking forward to the non-COVID times and more travel,” he says. “I’m really attracted by all the diversity that’s here – the history and the cultures.”
When she attended Michigan’s prestigious Interlochen Arts Academy as a high school student, Evelyn Lockhart, MD, hung out with the drama kids and specialized in creating theatrical and special effects makeup.
Years later, she put those skills to use in an educational setting with her medical colleagues, brewing batches of realistic-looking stage “blood” for vivid presentations on transfusion and how to manage blood loss.
Now, Lockhart, an associate professor in UNM’s Department of Pathology, has taken her artistic interests in another direction. For the past few years she has steadfastly devoted herself to mastering the art of medical illustration.
While earning her master’s in biomedical communication at the University of Toronto, Lockhart mastered freehand drawing and a suite of high-end graphic design applications to create elegantly intricate images of human organs, blood vessels and insects.
Her coursework also extended into animation, data visualization and other methods for communicating complex information. Lockhart hopes to put her new skills to use in building a business in biomedical communications.
Her visual creations earner her the Inez Demonet Scholarship from the Vesalius Trust for Visual Communication in the Health Sciences.
Lockhart, who came to UNM after serving on the Duke University School of Medicine faculty, recalls taking just one drawing class in high school. A dawning interest in medical illustration led her to start building a portfolio of drawings – which eventually led to her master’s degree.
“A lot of this was online education,” she says. “I did an online program in natural history illustration.”
Back home in New Mexico, Lockhart hopes her work will help students in the health care professions gain a better grasp of the human body as they develop their skills.
“Our medical education is built on images,” she says. “During the pandemic, we have seen how images inform our understanding of medical and scientific concepts. Medical illustrators have a responsibility to create their visualizations as accurately as possible.”
@ UNM Sandoval Regional Medical Center & Health Sciences Rio Rancho Campus
@ UNM Sandoval Regional Medical Center & Health Sciences Rio Rancho Campus
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Construction is underway on The University of New Mexico Center of Excellence for Orthopaedic Surgery & Rehabilitation, a new facility on the UNM Health Sciences Rio Rancho Campus that will unite clinical, educational and research activities under one roof.
The two-story 50,000-square-foot structure, located adjacent to UNM Sandoval Regional Medical Center (SRMC) in Rio Rancho’s City Center, is expected to open next November, said Jamie Silva-Steele, RN, MBA, SRMC’s president and CEO. It will include exam rooms for patients to consult with surgeons, an extensive orthopaedics research laboratory and a rehabilitation facility.
“It’s such a great synergy with what’s happening already at SRMC,” Silva-Steele said, noting that the hospital already hosts a robust joint replacement practice. “What I envision over the five-year period is that we’ll add five more total joint surgeons, plus learners. It just helps us to maximize our surgical platform.”
The $21 million project is being funded through Rio Rancho’s gross receipts tax revenues, with some of the money coming from cash on hand and $15 million from bonds raised against future tax receipts, she said.
The majority of UNM Health’s joint replacement surgeries, including total hip, total knee, foot and ankle, elbow and shoulders, are already being performed at SRMC.
The new facility will also provide ample space for research, said biomechanical engineer Christina Salas, PhD, assistant professor in the Department of Orthopaedics & Rehabilitation and special assistant to the dean of the School of Engineering. It will also include room for a cadaver lab and two Biosafety Level 2 workstations.
Salas, who currently operates three laboratories at the UNM Health Sciences Center and the UNM School of Engineering, typically has five to 10 graduate students and between 10 and 15 undergraduates working at any given time.
“I'm really excited because I currently have three labs on two separate campuses and I spend a lot of my time driving back and forth,” she said. The design will also accommodate visitors who can safely view the work being done through a glass wall, reflecting the facility’s educational mission, Salas said.
The new facility is a major step forward in a 30-year master plan for the UNM Health Sciences Rio Rancho campus, Silva-Steele said.
Additional centers of excellence could eventually be located in the vicinity, she said, and the city is opening a multi-use community center nearby. There are long-term plans to add landscaping, short-term housing, retail space and other amenities to the mix.
Silva-Steele credited Rio Rancho for its vision in helping to grow the Health Sciences Center’s presence.
“It’s worked magically, where the city has a strong desire to use the gross receipts tax,” she said. “There’s a lot of desire for the community to see the benefit of having UNM here.”
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As the governing principle of computing, logic is one of the most important tools in all science and technology. It also guides Tudor Oprea, MD, PhD, to ask philosophical questions about what diseases are and how to find new drugs to treat or cure them.
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As the governing principle of computing, logic is one of the most important tools in all science and technology. It also guides Tudor Oprea, MD, PhD, to ask philosophical questions about what diseases are and how to find new drugs to treat or cure them.
"To be frank, there are nights sometimes where I can't sleep because of this,” he says. “We don't have answers, and most scientists I talk to don't seem to be bothered by it.” This unease and his approach to correct it has guided Oprea’s curiosity and determination throughout his career.
Oprea, professor and chief of the Translational Informatics Division in The University of New Mexico’s Department of Internal Medicine, grew up in Romania, where he learned to approach everything with a healthy dose of skepticism.
"That's the first thing about growing up there – the (Communist) party lies – which led to me refusing to read anything in the Romanian language, because I thought everything was a lie," he says.
Instead, Oprea sought out science fiction and other books in English and French, including one in particular. "Somehow, a book of general chemistry fell into my hands and I started reading it like a novel," he recalls.
That was the moment Oprea knew he wanted to study chemistry, but when he was recruited by the army, they discovered he was partially color blind – which in Romania meant he couldn’t drive, work with computers or study chemistry (though he has done all three since).
So, he decided to pursue his MD/PhD at the University of Medicine and Pharmacy while enduring government-scheduled blackouts and hot water shutoffs. In his spare time, Oprea also sought out experts at his university to teach him quantum chemistry and how drugs interact with protein receptors.
However, while volunteering at a county hospital near his hometown, a government-induced steroid shortage led to the deaths of 10 patients from anaphylaxis. “I decided I don't want to be a physician in a system that kills people,” Oprea says.
Luckily, his boundless curiosity set him on a new path.
After seeing three-dimensional molecular models for the first time, Oprea took postdoctoral positions studying molecular and protein modeling in Missouri and New Mexico, followed by a research position at Astra Zeneca in Sweden and a professorship at West University of Timișoara in Romania.
There, his interest evolved again – this time it was drug discovery.
Oprea returned to New Mexico in 2002 to work on high-throughput drug screening with Bruce Edwards, PhD, and Larry Sklar, PhD, in UNM’s Center for Molecular Discovery. He went on to build the Drug Central database for drug discovery, discover novel cancer drugs with his collaborators Eric Prossnitz, PhD, and Angela Wandinger-Ness, PhD, and lead the Knowledge Management Center for Illuminating the Druggable Genome.
Today, Oprea’s focus has shifted to the unknown, including the dark genome – genes and proteins whose functions in the human body are not well understood – and rare diseases. Oprea has turned to computing to help decipher these mysterious topics.
"When I take all this knowledge and I try to patch it together, I'm looking at what are the definitions for diseases,” he says. “I'm trying to map diseases to targets to drugs."
In his mind, Oprea’s proudest achievement so far has been to get two drugs – raltegravir and ketorolac – into clinical trials to treat cancer through his collaborations with UNM researchers and physicians. "I'm really rooting for us having a drug on the market,” he says, “because I think it would really help put the university on the map of drug discovery."
Clinical trials play an important part in cancer care. They enable physicians and scientists to improve care over time and may even help trial participants by giving them access to life-saving treatments before those treatments are generally available.
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Clinical trials play an important part in cancer care. They enable physicians and scientists to improve care over time and may even help trial participants by giving them access to life-saving treatments before those treatments are generally available.
Sarah Adams, MD, a gynecologic oncologist and cancer scientist, hopes her national clinical trial may not only help women fight ovarian cancer but also keep it contained.
Ovarian cancer has unclear symptoms and no screening tests that catch it in its early stages, before it has spread to lymph nodes or other organs. Fewer than half of women diagnosed with ovarian cancer live for more than five years after diagnosis and those survival odds haven’t changed significantly for some time.
If detected at early stages, the five-year relative survival rate is greater than 90 percent, according to the National Institutes of Health Surveillance, Epidemiology, and End Results Program. However, in almost 60 percent of women diagnosed with ovarian cancer, the cancer has already metastasized.
Although ovarian cancer can be treated with chemotherapy and surgery, the cancer eventually returns in most women, resulting in the poor overall survival rate. Adams has developed a new treatment that is being tested in women with recurrent ovarian cancer after chemotherapy.
Adams is the Victor and Ruby Hansen Surface Endowed Professor in Ovarian Cancer Research at The University of New Mexico Comprehensive Cancer Center and an associate professor in the Division of Gynecologic Oncology in the UNM Department of Obstetrics & Gynecology.
Her initial studies in cancer models were supported by the UNM Cancer Center, an early career research award from the Ovarian Cancer Research Fund Alliance and pilot funding from the Oxnard Foundation.
These studies demonstrated the success of combining two treatment approaches: tumor-directed therapy using a PARP inhibitor to kill cancer cells and immunotherapy using an antibody to sensitize the immune system’s T-cells to the ovarian cancer cells. Adams is now testing this combination in phase 1 and phase 2 clinical trials.
Adams opened an ovarian cancer clinical trial at the UNM Cancer Center in 2016. The clinical trial, which was based on her own research discoveries in cancer models, had promising early results and so was selected to be the first national clinical trial opened through the Oncology Research Information Exchange Network, a consortium of 18 National Cancer Institute-designated cancer centers. This study completed enrollment in July 2020.
Adams’ research initially focused on BRCA-related ovarian cancer. BRCA1 and BRCA2 are genes we all carry and encode proteins involved in DNA repair. Women with BRCA gene mutations face a high risk of breast and ovarian cancer. Cells with mutated BRCA genes rely on alternative DNA repair pathways that use a class of proteins called poly (adenosine diphosphate-ribose) polymerase, or PARP.
Adams’ therapy uses a PARP inhibitor that kills the cancer cells by keeping the PARP proteins from accomplishing their repair work. PARP inhibitors do not affect healthy cells because those have working BRCA proteins with which to repair their DNA. “The therapy is specific to cancer cells,” says Adams, “so it’s nicely targeted.”
Research by Adams and others has shown that immune therapy is especially potent against BRCA-related ovarian cancer. It enhances a person’s immune response to their cancer and teaches their immune cells to recognize the cancer if it ever comes back. The immune therapy in Adams’ trial is an antibody that sustains T-cells’ ability to recognize and devour cancer cells.
Adams’ combination therapy kills cancer cells and also enables the immune system to eradicate the tumor. So, if the PARP inhibitor doesn’t kill the tumor cells, the immune system does.
Based on early results from the trial launched at UNM, Adams developed a second study to test whether this regimen can help a larger group of women, including those who do not have a BRCA mutation. This study was developed with NRG, one of the NCI Cooperative Oncology Groups that runs national clinical trials. This randomized phase 2 trial was opened at centers across the nation in October 2019 and Adams serves as the national study chair.
Adams has achieved a major accomplishment in the translation of her discovery science to national clinical trials, says Cheryl Willman, MD, director & CEO of the UNM Comprehensive Cancer Center. “This is considered one of the highest, and most difficult, achievements that any cancer investigator or cancer center can attain.”
Ultimately, Adams and her team hope to boost the immune systems of women with ovarian cancer so that their bodies keep the cancer at bay once the tumor is removed or killed. And while conducting a clinical trial can be nerve-wracking, because the health of so many women is at stake, Adams also finds great satisfaction.
“Being able to sit across from a patient on the [clinical] trial and being able to talk to her about evidence of her treatment response was incredibly moving for me, and incredibly gratifying,” Adams says. “[It was] the highlight of my whole career, truly.”
Responding to multiple tragedies that have convulsed the country over the past year, The University of New Mexico College of Population Health has committed to tackling the scourge of racism head-on.
While combatting racism has always been central to the field of public health and population health, racist injustices like the deaths of Breanna Taylor and George Floyd lend new urgency to the mission. Add COVID-19, which has disproportionately affected people of color, and you have the makings of a wildfire.
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Responding to multiple tragedies that have convulsed the country over the past year, The University of New Mexico College of Population Health has committed to tackling the scourge of racism head-on.
While combatting racism has always been central to the field of public health and population health, racist injustices like the deaths of Breanna Taylor and George Floyd lend new urgency to the mission. Add COVID-19, which has disproportionately affected people of color, and you have the makings of a wildfire.
But these tragedies also presented an opportunity to build on the mission that has defined the College of Population Health since its founding in 2016. Now, the College is bringing together faculty members from across UNM to expand anti-racism efforts into curricula, hiring and training practices, and to explore how anti-racist efforts can affect community health outcomes.
“It’s a multiethnic, multiracial, multicultural team,” says acting dean Nina Wallerstein, DrPH, who helped found the College of Population Health and is director of its Center for Participatory Research. “I’m a White faculty member, but we have Native, Latinx, African-American and White members.”
The idea is to create “courageous conversations” among students, faculty and staff, Wallerstein says, adding that discussions have also focused on policies and practices regarding hiring and retention policies for faculty of color and the university’s policies in terms of salary equity. “We’re trying to transform our entire unit, because we’re small and have the capacity to implement a lot of changes faster.”
Addressing equity and racism has been part of a multipronged understanding of how to address core public health and population health issues, Wallerstein says. “A lot of us have always been teaching about anti-racism, but to bring the whole College together with a specific vision and purpose is new.”
The initiative started last year, when then-dean Tracie Collins, MD, MPH, convened a college-wide meeting to discuss the expanded agenda. She then appointed an executive team, led by Wallerstein, to drive the agenda of the future meetings.
“The idea is how does a College of Population Health have an impact in this area, and what is our role,” Collins said at one of the movement’s bi-monthly Zoom meetings. “This is not going to be a one-time thing for a few weeks or a few months. We have to figure out how to embed this movement into all aspects of our curriculum. How do we hold ourselves accountable in our relationships with tribal communities, with African-Americans, with Latinos?”
Team members include Jamal Martin, PhD, MPH, who teaches in Africana Studies and in the Department of Family & Community Medicine, while also serving as associate vice chancellor for African-American Health in UNM’s Office for Community Health.
“This is nothing new,” Martin says. “It has been a journey for a long time. It is a revolution. We’ve got 500 years of colonial thinking to overcome.”
Task force member Rebecca Rae, associate director of Indigenous Research, Evaluation, and Strategic Planning at the Center for Participatory Research, sits on an advisory committee for the Native American Relief Fund – which is taking direct action.
“Through generous donations, the Native American Relief Fund has been able to give immediate financial assistance to tribes and tribal grassroot groups that have been providing PPE, food and other necessities to Native American families and communities,” Rae said.
Another College faculty member, Crystal Lee, PhD, MPH, has raised more than $150,000 in COVID-related donations for Navajo and Hopi communities through her non-profit, United Natives.
“Public and population health should be the places where we’re having talks about anti-racism, because it really does affect people’s health and if we can’t start it here at the College level, then we’re not going to be able to carry it forward,” observes team member Tonya Covington, a restorative justice expert who heads the Albuquerque Police Department’s Rapid Accountability Diversion program.
The final area of anti-racism work is community-based participatory research and action, which involves both scholars and advocates. This work was already underway even before the anti-racism team was born. Many of the projects involve Native, Latinx and African-American communities, which have been especially hard hit by COVID-19.
As a highlight of these community research efforts to address racial inequities, the Transdisciplinary Research, Equity and Engagement (TREE) Center for Advancing Behavioral Health serves Latinx, indigenous and frontier/rural and other underserved communities.
TREE director Lisa Cacari-Stone, PhD, received a National Institutes of Health grant to study how local and state government COVID-19 policies are mitigating existing health inequities and to disseminate best practices locally and nationally.
Wallerstein and her colleagues have long conducted participatory research with tribal education and health departments. With the coronavirus, priorities and challenges are changing, she says.
“It’s hard now for all of us doing community-engaged research or service, because we’re so used to driving out to the communities, with many, such as tribes, closed to protect themselves,” Wallerstein says.
Florence Nightingale, whose 200th birthday celebrated this year, was the first nurse scientist and the founder of modern nursing.
The Crimean War shaped her practice and mission to improve the health and hospital conditions, decrease the infection rate and increase survivability in the soldiers entrusted to her care. She kept careful records and statistics of what worked and what didn’t. Much like Nightingale, today’s nurses are now in a similar situation with the COVID-19 pandemic.
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Florence Nightingale, whose 200th birthday celebrated this year, was the first nurse scientist and the founder of modern nursing.
The Crimean War shaped her practice and mission to improve the health and hospital conditions, decrease the infection rate and increase survivability in the soldiers entrusted to her care. She kept careful records and statistics of what worked and what didn’t. Much like Nightingale, today’s nurses are now in a similar situation with the COVID-19 pandemic.
Patricia Watts Kelley, PhD, APRN, the new associate dean for research and scholarship in The University of New Mexico College of Nursing, has a vision for students and faculty based on her view that a successful career involves continual professional growth and mentorship.
“It’s an evolutionary process,” Watts Kelley says. “As people advance in their careers, I believe you’re obligated to bring the next generation along.”
Watts Kelley saw this firsthand as she went from a high school student working in a nursing home to a 21-year career in the Navy. She earned a PhD while in the Navy and advanced up the career ladder to become the first Navy executive director of the Triservice Nursing Research Program, among other key leadership positions.
Watts Kelley is using her own career experience to guide the reinvigoration of scholarship and research in the College. “Our preparation as nurses is based in the sciences and the humanities since the profession of nursing is an art and a science,” she says. “It’s also a skillset that you develop over time.”
Watts Kelley also knows that the rigor of science and scholarship requires support from the institution itself. “I want to ensure that the nurses and other scientists in the College of Nursing develop scholarly projects to disseminate their best practices, generate science to answer pressing health care questions and encourage them by developing infrastructure,” she says.
Watts Kelley wants to increase funding for research and scholarship for the College of Nursing while increasing its academic rankings. But her biggest focus lies in educating the next generation clinicians, educators and scientists.
“I want us to prepare a solid group of students with good foundations in clinical practice, scholarship and research – along with professors who can nurture, mentor and grow these students – to address the health care needs of the citizens of New Mexico,” Watts Kelley says.
In order to serve the state, the country and the world, Watts Kelley says it is important that the college teach their students how to not only apply their knowledge in the clinic, but also use it to educate others.
“We need to graduate experts at all levels within the College of Nursing – excellent clinicians at the bachelor’s level, excellent practitioners at the master’s and DNP level and nurse scientists at the PhD level – to explore questions and illuminate problems,” Watts Kelley says.
These experts will be able to serve their communities by focusing on the health issues that plague New Mexicans, from poverty to toxic chemical exposure, she says.
“My goal is to have UNM nursing faculty ready to address the (state’s) health care needs for the next 20 to 50 years, whether it’s during a pandemic or addressing complex chronic conditions by giving patients the tools to manage their own care with some guidance,” Watts Kelley says.
Despite the challenges awaiting her, Watts Kelley is excited to help College of Nursing students grow and learn about what their profession really means.
“Nurses bear witness to the human condition,” she says. “Sometimes you need to learn how to support and witness that because you can’t always fix things, whether you try to do it with science or practice. Sometimes you just have to be with the patient and acknowledge their humanity.”
Local officials in northern New Mexico’s San Miguel County had noticed a troubling trend in their community: a rise in depression and suicide among Latinx rural youth, a group that already at a higher risk for mental health issues. The county partnered with UNM’s College of Population Health to investigate solutions.
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Local officials in northern New Mexico’s San Miguel County had noticed a troubling trend in their community: a rise in depression and suicide among Latinx rural youth, a group that already at a higher risk for mental health issues. The county partnered with UNM’s College of Population Health to investigate solutions.
It was the right choice. The College, established in 2016, prioritizes social justice concerns and implements solutions by listening to communities, then works with them to fashion interventions.
“We have our own set of values and principles, which include partnering with communities and tribes and policymakers,” says Nina Wallerstein, DrPH, who helped start the College in 2016 and is the director of its Center for Participatory Research. In its first year, the College integrated the master of public health degree program and inaugurated a new bachelor of science in population health.
Shannon Sanchez-Youngman, PhD, associate director for Participatory Research and Evaluation in the Center for Participatory Research, set up a pilot research program through the College’s Transdisciplinary Research, Equity and Engagement (TREE) Center for Advancing Behavioral Health. Five male and female youth leaders in the county constructed video narratives portraying stories about their views of the roots of depression and suicide in the northern New Mexico community.
The point, Sanchez-Youngman says, was “not to make videos that tug at parents’ heart strings,” but to harness a dialogue method for addressing structural racism with arts-based narratives. The videos highlighted deep feelings of alienation and isolation that predated COVID-19. Their youth creators are now hosting speak-back sessions and policy dialogues with the county commission.
Meanwhile, Sanchez-Youngman and the College of Population Health are expanding the project to eventually develop “innovative ways of tackling community health outside of the clinical walls,” she says.
This is just one example of the College of Population Health's commitment to local engagement.
“Communities are the driving force for public health,” says Rebecca Rae, associate director of Indigenous Research, Evaluation, and Strategic Planning at the Center for Participatory Research. Rae is closely involved with RezRIDERS, a “Tribally Driven Extreme Sports Leadership Program for Youth” at Santa Clara Pueblo.
“Communities know the root issues,” she says. “If you’re thinking about equitable change you need to have the community in the forefront.”
A curriculum created by MPH graduate Greg Tafoya forms the core of RezRIDERS, which stands for Reducing Risk through Interpersonal Development, Empowerment, Resilience & Self Determination.
“It’s a year-long culture-centered leadership program tailored to working with youth using extreme sports to enhance self-confidence,” Rae says. The program follows the water cycle, starting with snowboarding in the winter, summer rafting and stand-up paddle boarding. It also includes a high ropes course and outdoor climbing and culminates with the youths completing a community action project.
Not only has RezRIDERS produced gains on measures of hope, empowerment and optimism, “the pueblo has seen a decrease in juvenile justice incidents over the past several years,” Rae says.
Undergraduate and graduate students are an integral part of the College’s community outreach. The MPH program requires candidates to dedicate 160 hours (virtually, for now) with an agency, program or non-profit over the course of a summer, says S. Noell Stone, MPH, the College capstone and practicum director. Undergrads perform 225 hours of community work.
“The purpose of these field experiences is to help them try something new or think of a new program within the place and to get to know someone who can help them in their career,” Stone says. So far, students have helped organize COVID-19 briefings for the governor, analyzed survey data from seniors experiencing homelessness and more.
MPH students stepped up when the worst health crisis in a century struck New Mexico and the world. The City of Albuquerque quickly recognized a major risk factor for spreading COVID-19: people experiencing homelessness who could not shelter in place. Officials set up a coalition of partners to address the problem, enlisting the expertise of the new College of Population Health.
The first task? Conduct a survey of homeless seniors to understand why they were not sheltering in place at dedicated community centers. Through their practicum, MPH students analyzed the surveys to find the core problem. Seniors were not staying at the community centers because of the quality of the food and medical services. The coalition pulled together to improve food and medical care and even provide games (Corn Hole is a favorite).
“We went from 25% of the seniors staying to 75%. That’s a huge difference, and that means that less people are being exposed,” says Laura Chanchien Parajón, MD, MPH, who holds a secondary faculty appointment with the College of Population Health and is the executive director of UNM’s Office for Community Health, and until recently served as medical director of Albuquerque’s COVID-19 Response for People Experiencing Homelessness before joining the New Mexico Department of Health as a deputy cabinet secretary. “The community had the solution and everyone chipped in where they could to make the solution happen.”
Social justice and health equity “are in the DNA of public health,” Wallerstein says. “The values of the College of Population Health mimic the vision of the Health Sciences Center, but we bring our own contribution and insights.”
Last July, Zoneddy Dayao, MD, assumed the roles of chief medical officer of the UNM Comprehensive Cancer Center and interim chief of the Division of Hematology/Oncology in the Department of Internal Medicine.
The timing might have seemed inauspicious, coming right after the upheaval of COVID-19 closures throughout the nation and just as the new normal was sinking in, but Dayao gracefully eased into the roles and got to work.
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Last July, Zoneddy Dayao, MD, assumed the roles of chief medical officer of the UNM Comprehensive Cancer Center and interim chief of the Division of Hematology/Oncology in the Department of Internal Medicine.
The timing might have seemed inauspicious, coming right after the upheaval of COVID-19 closures throughout the nation and just as the new normal was sinking in, but Dayao gracefully eased into the roles and got to work.
Dayao first focused on creating processes to regulate the number and flow of patients physically seen at the UNM Cancer Center. During the first months of the global pandemic, the Cancer Center remained open and continued to provide care for patients on active treatment, but it transitioned nearly 30% of its patients to telephone visits.
Those receiving visits remotely included cancer survivors, well patients and those with follow-up visits. The Center was able to reduce the number of people coming into its clinic by about two-thirds during the initial surge in COVID cases.
“Our first goal was to assure that we could continue to safely deliver cancer care for our patients, who are too often fragile and immunosuppressed, in our outpatient clinical environment rather than in the hospital,” says Cheryl Willman, MD, director and CEO of the UNM Cancer Center.
Keeping the UNM Cancer Center open seven days a week decreased the number of ER visits and potential admissions for cancer patients. The seven-day schedule also gave UNM Hospital increased hospital admission capacity for other patients, particularly those with COVID-19.
Even before she assumed her new roles, Dayao worked with her predecessor, Richard Lauer, MD, and the clinic team to change internal processes. They secured personal protective equipment (PPE) for the Center’s faculty and staff and enacted changes to limit the number of people entering the building.
These measures included limiting clinic access to cancer patients and a single caregiver, health care providers and essential staff; daily screening of everyone who entered the building; requiring everyone to wear surgical procedure masks and other PPE in the clinic and enforced social distancing.
Within a few days of the announcement of the public emergency, the UNM Cancer Center created a designated area for COVID-19–positive patients or those with the potential of having COVID-19. In this area, staff were equipped with the appropriate PPE and patients whose treatment could not be interrupted could safely continue to receive therapy.
The Center also “fast-tracked” asymptomatic but severely immunocompromised patients, particularly those with blood-related malignancies. These patients received a quicker check-in process and an escort directly to treatment areas.
Originally from the Philippines, Dayao received her medical degree in Integrated Liberal Arts and Medicine Program at the University of the Philippines – College of Medicine.
Admission to the highly competitive seven-year program (most programs require nine years) is offered only to the top 40 of approximately 20,000 aspiring students nationwide.
Dayao completed residency training in internal medicine at Cook County Hospital in Chicago and fellowship training in hematology/oncology at the University of Miami.
During her training, Dayao received the Outstanding Resident Award and was selected as chief fellow and was the first recipient of the William Harrington Outstanding Fellow Award. She also received an institutional award for her work on graft-versus-host disease in the laboratory of Robert Levy, PhD. She subsequently received the prestigious Young Investigator Award from the American Society of Clinical Oncology.
In 2008, Dayao joined the Division of Hematology/Oncology in the UNM Department of Internal Medicine and the UNM Cancer Center. Since then, she has assumed several clinical leadership roles, including chair of the Cancer Committee. She oversees creation of multiple service lines, clinical operations and programs in quality, accreditation and certification.
Dayao is an oncologist, first and foremost, an expert in the treatment of breast cancer and an academic physician who takes her roles as a teacher and mentor seriously.
Breast cancer management is so complex and lengthy that hematology/oncology fellows often do not see the full spectrum of this disease during their training. Dayao pioneered an innovative interactive breast cancer curriculum to supplement fellows’ training, and they love the case-based and board-oriented approach.
She has also been active in teaching at the School of Medicine and also has delivered many lectures to providers in local and regional symposia on breast cancer and clinical trials.
Dayao envisions a seamless transition for cancer survivors from their oncologists to their primary care providers, but this vision requires educating primary care providers about cancer and survivorship. Her research in breast cancer symptom control, quality of life and cancer survivorship has been supported by the National Cancer Institute and the New Mexico Department of Health.
Dayao has also been the local principal investigator of the Alliance for Clinical Trials in Oncology (ALLIANCE), one of the five national clinical trials network sponsored by the National Cancer Institute.
Cancer clinical trials can be a crucial component of cancer care. Dayao represents the UNM Cancer Center in the bi-annual meetings, oversees the preparation of triennial audits, engages junior faculty to become active members of multidisciplinary committees, and promotes accrual to clinical trials.
As a clinician, educator and administrator, Dayao influences the care New Mexico cancer patients receive. And they can rest assured that she is expertly overseeing all the aspects of their care.
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Six months after it opened, the Behavioral Health Clinic at The University of New Mexico Health Sciences Rio Rancho campus was just establishing its role in Sandoval County. “There was lots of outreach, lots of engagement, and then the (COVID-19) pandemic struck, and all that engagement really came to a screeching halt,” says clinic director Christopher Morris, PhD. “But, of course, the patient needs did not stop.”
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Six months after it opened, the Behavioral Health Clinic at The University of New Mexico Health Sciences Rio Rancho campus was just establishing its role in Sandoval County. “There was lots of outreach, lots of engagement, and then the (COVID-19) pandemic struck, and all that engagement really came to a screeching halt,” says clinic director Christopher Morris, PhD. “But, of course, the patient needs did not stop.”
Morris, a clinical psychologist and associate professor in UNM’s Department of Psychiatry & Behavioral Sciences, says that the clinic’s operations moved to nearby UNM Sandoval Regional Medical Center (SRMC) to continue providing care for patients. But when the hospital began limiting number of people allowed in, the clinic’s staff found themselves working at home.
“That was one of the biggest challenges early in the pandemic,” Morris says.
The staff finally returned to the clinic in June and were inundated with patients. “The net effect of the pandemic was that it increased our referrals and our volume,” he says.
Morris explains that in mental health care, clinicians expect about 25% of patients not to show up to appointments. “Our no-show rate for a few months dropped to nearly zero, so people were in distress, and distress is a powerful motivator,” he says.
Morris thinks that this influx was probably due to current patients whose symptoms worsened during the pandemic and to new patients who were directly dealing with COVID-19. These new patients lost loved ones and jobs, or missed out on significant life events and needed care to cope with those losses.
The clinic found that balancing telehealth, video calls and in-person visits for patients who wanted them was key to handling the patient influx.
“As we got back into our clinic space and developed that mix of in-person and virtual visits, people really adapted,” Morris says. “The team has been amazing.”
Despite their resilience, the mental needs of health care workers will need to be attended to going forward, says Jamie Silva-Steele, RN, MBA, SRMC’s president and CEO.
“The mental toll on people this year has been enormously substantial for everybody, but in health care, we actually have people who are reconsidering their profession or getting out of health care altogether,” she says.
Even in the midst of these two crises, Morris says that virtual visits have been one positive side effect. “It’s been a really powerful way of facilitating patient access that we want to continue,” Morris says.
Meeting virtually has also allowed Morris to continue stalled community partnerships. “I think, as many people have found, that’s powerful,” he says. “It allows us all to be more efficient and, in some ways, actually more connected.”
Silva-Steele found that virtual meetings allow her to check in with and support her teams no matter where they are. “People can continue to take care of themselves, become resilient as team members and focus on their own well-being,” she says.
And thanks to mill levy funds that Sandoval County voters approved in 2018, the clinic’s prioritization of access and community engagement will continue. “If it was just SRMC as a community hospital without mill levy funding, these would not be services that we would have within the organization,” Silva-Steele says.
The Behavioral Health Clinic is funded entirely by the mill levy, which helps the clinic remain open to serve and educate the community.
“What that really allows us to do is support the educational mission,” Morris says. In the past year, the clinic hosted a clinical psychology post-doctoral fellowship and attending physicians in psychiatry, which will help bring in resident physicians and interns next year.
The funds also enable more community outreach programs, including partnerships with Rio Rancho Public Schools and Sandoval County to offer Mental Health First Aid, an evidence-based curriculum that teaches people how to respond supportively to someone in mental health distress.
The curriculum – available in English and Spanish – has specifically designed instructional modules for young people, older adults, public safety workers, veterans and others. The clinic plans to make these curriculums available to rural and Native American communities throughout the county.
“We’re serving the community at large, not only UNM patients referred internally,” Morris says. “Anyone from the community can access care here and it’s important to have another source of behavioral health care in the community.”
Johnnye Lewis, PhD, wears a lot of hats in the College of Pharmacy – from research professor to director of the College’s Community Environmental Health Program, director of the UNM METALS Superfund Research Program Center and co-director of the Center for Native American Environmental Health Equity Research.
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Johnnye Lewis, PhD, wears a lot of hats in the College of Pharmacy – from research professor to director of the College’s Community Environmental Health Program, director of the UNM METALS Superfund Research Program Center and co-director of the Center for Native American Environmental Health Equity Research.
Add a new title to the list: principal investigator of the Navajo Birth Cohort in a far-reaching national study of children. The ECHO, or Environmental Influences on Child Health Outcomes, study will follow tens of thousands of children across the nation to mine data on how various environmental factors – anything from obesity to parental stress to chemical exposures – affect growth and development.
Partners in the research include the Southwest Research and Information Center and the Navajo Nation Department of Health’s Community Health Worker and Outreach Program, with support from several Indian Health Service (IHS) and tribally managed hospitals on the Navajo Nation.
Lewis’s piece of the puzzle will involve uranium and metals exposure and Native American families, an extension of a years-long relationship between the College of Pharmacy and the Navajo, or Diné, people of New Mexico, Arizona and Utah.
The Navajo Birth Cohort Study began in 2010, looking at the effects of metals exposure in Navajo parents living near abandoned uranium mining sites on the Navajo reservation and tracking those effects during pregnancy and in the first years of a child’s life.
The study found higher-than-normal metals levels in participants and suggests that being exposed to a combination of metals during pregnancy increased the likelihood of pre-term birth; that some babies are born with high levels of uranium and other metals; and that there is evidence that these exposures in children continue to increase at least through early childhood.
Lewis is excited about the prospect of extending the study and broadening it and is working with the IHS and other health care providers on the Navajo Nation to inform evidence-based pediatric treatment.
“A lot of those impacts of environmental exposures develop later in life, so this gives us the opportunity to follow those kids through age 8,” she says. This study also includes cohorts from the Cheyenne River Sioux and Oglala Sioux tribes. With a much larger sample, “You get a much better sense of what is common over multiple populations and you get to think about how well treatment strategies work in different cultures. IHS has never had Navajo-specific data to drive treatment decisions. So, we’re really excited about that.”
In addition to the ECHO study, which brings $4.2 million into the College of Pharmacy annually until 2023, Lewis has three other large ongoing grants.
A $1 million annual grant from National Institute of Environmental Health Sciences (NIEHS) and the Environmental Protection Agency funded the creation of the UNM Center for Native American Environmental Health Equity Research. In its first five years, with Melissa Gonzales from the UNM School of Medicine as co-director, the center worked with tribal partners on the Navajo Nation, the Crow Tribe in Montana and the Cheyenne River Sioux Tribe in South Dakota conducting biomedical and environmental research into how exposure to metal mixtures affect health.
A $1.4 million annual extension of that grant through 2025 allows the center to continue working with those tribal partners but changes the focus to how solid waste disposal techniques, especially burning plastics, exacerbate metals exposures and increase disease risk.
The newly renewed center is funded by the National Institute on Minority Health and Health Disparities. It includes collaborators from the University of Oklahoma and Montana State University in Billings, and includes leadership roles for two former Career Development Investigators in the original center who have begun new faculty careers at those institutions: Joe Hoover will serve as MPI with Lewis and MacKenzie, and Jorge Gonzalez Estrella will lead the microplastic investigations.
Lewis’s METALS (Metal Exposure and Toxicity Assessment on Tribal Lands in the Southwest) Superfund Center is funded for five years at $1.2 million each year through 2022 by the NIEHS. It is the first such center focused on integrated health-based and environmental science research on metal mixtures within Native American communities.
Along with collaborations from the UNM School of Engineering and the Departments of Earth and Planetary Sciences, Geography, Statistics, the UNM Comprehensive Cancer Center and the School of Medicine, the center includes collaborations with Laguna Pueblo and Navajo communities, as well as the Southwest Research and Information Center, the Indigenous Education Institute and Stanford University.
The work has led to the important finding that the material left behind in some mining sites, which when exposed to the weather, is reduced to nano-sized particles, making them potentially even more dangerous.
If there is a theme to all this, it is doing science that is collaborative and solutions-oriented.
“We have a really strong connection to Native American communities and we’ve made a really important contribution,” Lewis says. “I think we’ve shown the value of the approach of moving from the environment to people to the laboratory and back to people. And the value of solution-oriented research. We work to understand how things happen and come up with interventions Native communities can benefit from.”
An example is a clinical trial called “Thinking Zinc” in two Navajo communities in New Mexico. A team of three College of Pharmacy faculty – Laurie Hudson, PhD, a UNM Regents’ professor of Pharmaceutical Sciences, MacKenzie, a research assistant professor and deputy director of the Community Environmental Health Program and Esther Erdei, PhD, a research assistant professor – are several years into an investigation to determine whether dietary zinc supplements can mitigate the effects on the immune system of toxic exposure to uranium and arsenic.
The clinical study builds off laboratory work by Hudson and Jim Liu, PhD, professor of Pharmaceutical Sciences that showed the ability of zinc to repair DNA and change immune response. If researchers know that arsenic and uranium can displace zinc in proteins involved in immune responses and the repair of DNA, the Hudson, MacKenzie and Erdei team asked, might supplementing zinc intake – one small 15 milligram tablet – each day help repair the damage?
Participants in the study are Navajo and live near mine spill sites. Participants are monitored for six months before taking zinc and six months while they take the supplements, looking for changes in immune response and DNA repair.
“It’s the kind of intervention that fits really well in the community way of thinking about science,” Lewis says, “because you’re looking at a system that’s been disturbed and you’re putting it back into balance by reintroducing metal that should have been there all along.”
MacKenzie, an immunologist and molecular biologist and MPI for both the Navajo Birth Cohort Study/ECHO study and the UNM Center for Native American Environmental Health Equity’s recent five-year renewal, said the team is excited to expand its research into the connection between exposure to metals and microplastics through open trash burning in tribal communities – the Navajo, the Crow and the Cheyenne River Sioux.
Study participants in the Native American Environmental Health Equity Research study will wear a silicone wrist band that measures chemical exposure.
“We’re looking at the movement of microplastics and chemicals through the community and overlaying that on top of what we know about metals,” MacKenzie says, further expanding UNM’s portfolio of metals research.
“We’ve focused on metals and now we’re building on top of understanding metals exposure and expanding our understanding to a broader dynamic of exposures,” she says. “It’s very exciting work.”
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Everyone has been inundated with information about COVID-19 over the past year, but discerning which sources are reliable can be difficult. Where do we turn for accurate, up-to-date information? In one unexpected case, prison.
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Everyone has been inundated with information about COVID-19 over the past year, but discerning which sources are reliable can be difficult. Where do we turn for accurate, up-to-date information? In one unexpected case, prison.
In 2020, a group of inmate peer educators at Northeast New Mexico Correctional Facility (NENMCF) responded to the pandemic with educational workshops tailored to answer questions about COVID-19.
They included a 90-minute class on the virus offered to small, socially distanced and mask-wearing groups among the more than 400 inmates housed at the facility, located near Clayton, N.M. The class aimed to curb harmful misinformation and played an important role in the correctional facility’s pandemic response effort.
The inmate-led group is an arm of Project ECHO’s New Mexico Peer Education Project (NM-PEP), which has peer education groups in 11 state prison facilities across New Mexico.
“These guys are an elite group of peer educators,” program manager Daniel Rowan said. “A pandemic hits and they quickly develop and mobilize a workshop to address the new risk of COVID-19.”
The NENMCF group also circulated a prison newsletter that provided updates to the prison community on COVID-19. These initiatives required written proposals and approval from the warden, as well as collaboration with behavioral health staff.
Lindsey Fluhman, the prison’s behavioral health director, said peer educators help the prison community stay informed and calm during the pandemic.
“The peer educators do a good job at debunking rumors of false information that the inmates have heard from other sources,” Fluhman said. “Peers seem to respect and believe information from their own peers with more ease than from staff.”
The peer educators received an intensive weeklong 40-hour training with Project ECHO’s NM-PEP staff. Ongoing support was provided through biweekly videoconferences and monthly site visits. In turn, peer educators delivered monthly 10-hour community health workshops to the prison population with an emphasis on communicable diseases.
Access to reliable information is critical, said peer educator Michael Brown. “The most current and accurate information on COVID-19 makes it possible for us as peer educators to teach our community and for everyone to gain an understanding of a virus that is so widely misunderstood,” he said.
Though in-person site visits were disrupted by the pandemic, peer educators received updated COVID-19 information via videoconferencing to ensure the latest facts were available to their students.
These sessions included a presentation from epidemiology staff from the New Mexico Department of Health and infectious disease specialists, who provided real-time information and fielded questions from peer educators. COVID-specific sessions ended in late February 2021, and have since refocused on the treatment and prevention of hepatitis C virus (HCV).
NM-PEP was founded in 2009 by Karla Thornton, MD, MPH, Project ECHO’s senior associate director, as a way to provide HCV education in state prisons. She had been using the ECHO model to mentor providers in the prisons to treat HCV but realized that that treatment alone was not sufficient: education about HCV transmission was also needed. She recognized that education could help counter misinformation and reduce risky behaviors that spread the virus.
With close to 40% of New Mexico state prison inmates infected with HCV, misinformation about how the virus is spread poses hazards to a population living in close quarters.
“Peer educators in the New Mexico state prisons play a critical and essential role in promoting health and decreasing the transmission of infectious diseases in a very high risk environment,” Thornton said.
In this age of information, the need to promote accurate and up-to-date information is paramount. With mentoring from Project ECHO, inmate peer educators have found a way to leverage trustworthy information to reduce harm – perhaps offering a lesson for all of us.
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