Alum finds fascination in disease and the end of life

Robert Buckingham’s career has taken him around the world as he studies HIV/AIDS, prostitution and hospice care.

Robert Buckingham, Ph.D. ’78, saw a lot of people die when he served in the U.S. Navy during the height of the Vietnam War. But he was more drawn to illness-related mortality, even in combat zones. “In my travels throughout Southeast Asia during the war, I saw a lot of disease and death,” he said. “I got fascinated with diseases.”

Buckingham’s career has run on the tracks of disease and death ever since. Usually the tracks are parallel, but they have also diverged and intersected, frequently taking him back to the places in Southeast Asia where his interest was first sparked.

For Buckingham, an epidemiologist and professor of health science at New Mexico State University’s College of Health and Social Services, the intersection became personal as he entered the School of Public Health in the 1970s. His mother had just died of breast cancer, “so I was interested in the care she got—and the lack of care.” His frustration over the hospital’s aggressive attempts to keep her alive instead of alleviating her suffering led him to become involved in palliative treatment.

At the same time, the late Florence S. Wald, R.N. the former dean of the School of Nursing, was trying to establish the first inpatient hospice in the United States. Under Wald’s tutelage, Buckingham helped to write a grant proposal that led to funding for hospice care. In researching his doctoral dissertation, he came to the conclusion that care for the dying was better in a hospice than in a hospital.

The Connecticut Hospice opened in Branford in 1974. Today there are about 8,000 hospices around the world (including more than 4,500 in the United States), according to Stephen Connor, Ph.D., vice president of research and international relations at the National Hospice Foundation. Buckingham had a hand in developing about 90 of them. “Bob is remarkably intelligent and capable,” Connor said. “He certainly is someone well-regarded in the field.”

Buckingham moved on to other areas of public health, notably HIV/AIDS prevention among sex workers. He returned to Thailand as the AIDS epidemic spread and has since studied condom use among prostitutes in that country’s commercial sex industry and started a pediatric hospice for children with AIDS there. He spent the 2000-2001 academic year “developing programs for commercial sex workers as well as treatment programs for workers who were HIV-positive.” Before his research began, only 11 percent of sex workers’ clients had used condoms. His study, published in the journal AIDS Care in 2005, found that the rate had risen to 51 percent. It wasn’t ideal, but in some brothels as many as 89 percent of the workers’ clients use condoms, and overall the HIV rate in Thailand has “decreased significantly,” he said. Buckingham concluded that more focus needs to be put on native Thai patrons, who are less likely to use condoms than Western or other Asian customers.

Buckingham is trying to transfer that model of HIV prevention to prostitution in Latin America. One such place is Ciudad Juárez, Mexico, just across the border from El Paso, Texas, and not far from his campus in Las Cruces, N.M. “When you see poverty you see prostitution, and when you see prostitution you see disease,” he said. He has encountered little opposition from the authorities, even though Mexico is a heavily Roman Catholic country. “We usually don’t get interference,” he said. “We’re trying to help.”

Most recently, Buckingham has been asked by the government of Honduras to form the country’s first health commission. The need for health care is acute, especially for people living on the islands off the coast where care is “nonexistent,” he said. “What we’re doing is a simple needs assessment affecting the country.” He plans to get the project in full swing while on sabbatical in 2009-2010.

Honduras also has a disproportionately high share of Central America’s HIV/AIDS cases—some estimates have it as high as 60 or 70 percent—so Buckingham will work to promote condom use there. He will also likely be working with the dying, because he helped to establish a hospice in that country.

His work with hospices and sex workers isn’t all that divergent, he said—in fact, the two tracks crossed one day in Thailand. He was interviewing prostitutes when a woman, wrongly assuming that he was a physician, begged him to care for her sick infant. “I said, ‘I can’t take care of your baby,’ and gave it back to her. She said, “No, no!’ and just ran away. We brought it to the medical school. Sure enough, the baby was HIV-positive. Word went out that I found a place for these dying kids.”

Buckingham helped set up a hospice there, too. “Life is weird sometimes,” he said.

—John Dillon

An international traveler makes himself at home in the world’s great libraries

Wherever Stanley Simbonis, M.D. ’57, travels, he visits the local library. If it’s Athens, you’ll find him in the Gennadius Library at the American School of Classical Studies, or the archeological library at the British School at Athens, where he reads about the origins of language and writing. This research, of course, occurs after his annual six-week course in the Greek language at the University of Athens.

“The library is the heart and soul of the university,” said Simbonis, who is, not surprisingly, a trustee of the Cushing/Whitney Medical Library. “It’s the guts of the university, the crown jewel. How can you do without it? It’s been a storehouse of knowledge throughout the ages.”

If it hadn’t been for libraries, Simbonis might never have made it to the School of Medicine.

Born in Manhattan in 1928 to emigrants from Greece, Simbonis lived in a tenement apartment in the Bronx with his mother and brother; his father died when he was 8. Simbonis loved to look at the handful of books in his home until he discovered the public library on Washington Avenue; then he started to read everything from Churchill to calculus. At 13, when he finished school for the day, he wandered into the libraries and classrooms of Fordham University, where a chemistry professor allowed him to sit in on classes.

Simbonis’ junior high school science teacher steered him to the Bronx High School of Science, which still enjoys a reputation as one of the best college preparatory high schools in the country. He grew restless, however, in part because the school had no sports or even a gym at that time, and he dropped out at age 16.

“My original dream was to be a center fielder for the Yankees and then I tried to become a musician,” he recalled. “Medicine was my third choice.”

In the 1940s, trying out for a professional baseball team did not require an agent or experience. Simbonis just showed up at Yankee Stadium. He also took a crack at the Dodgers. Neither team hired him, so he knocked on doors all along Broadway to audition as a big band drummer. “I could barely keep a beat,” he said. He did, however, meet bandleaders Louis Prima and Harry James.

Still uncertain of his career path, he took on three menial jobs, delivering newspapers on Wall Street at 5 a.m., running mail for a ship’s broker and washing dishes at the Horn & Hardart automat. “The dishwashing really woke me up,” Simbonis said. “I thought, ‘What the hell am I doing here? It’s obvious that I have to go to school.’ The GI Bill sounded pretty good.”

Simbonis enlisted in the Marine Corps on September 2, 1945, the day the Japanese surrendered to the Allied forces, and began to pursue his high school equivalency degree. Because he took more than a dozen of the academic classes the Marines offered, he was called to the Marine Corps school in Washington, D.C., to teach English.

Simbonis planned to go to Columbia University and live at home after leaving the service, but his mother had remarried and moved to New Haven. He followed her to the city and enrolled in Yale College. Simbonis lived off campus above the Sisk Funeral Home on Howe Street, where he earned $25 a month and a free apartment for answering the telephone in the middle of the night. He majored in zoology and earned his undergraduate degree in 1953.

Simbonis then entered the School of Medicine, where he took an interest in pathology because it allowed time for research. After graduating he worked in the New York University lab of biochemist Severo Ochoa, M.D., who won the 1959 Nobel Prize for medicine or physiology for his discovery of an enzyme that can synthesize RNA. “Ochoa was brilliant, but also fun-loving,” Simbonis remembered. “He bought a red sports car with his prize money.”

After stops at Columbia University and Holy Name Hospital in Teaneck, N.J., Simbonis settled down at St. Joseph’s Hospital in Paterson, N.J., where he became chair of pathology. He retired in 1992 but remains an associate clinical professor of pathology at Columbia University’s College of Physicians and Surgeons, where he still audits classes.

Teaching, he said, was his greatest contribution to pathology. “I hope I was able to convey to students how to examine slides and specimens, and then think fiercely on how to synthesize the material at hand to arrive at reasonable conclusions,” Simbonis recalled. “It wasn’t an easy task but it was really worth the effort.”

Since 1975 Simbonis has lived in a historic brownstone in Greenwich Village, where he is active in neighborhood preservation. Divorced, he has no children. He travels widely and owns an apartment in Athens. He also has a vacation home on Fire Island, N.Y., which he has willed to the School of Medicine. The home will be sold upon his death and the proceeds divided between the library and a scholarship to be set up in his name. It will be a fitting gift from a lover of libraries.

—Alix Boyle

A life in public health takes an alumnus around the world and back to Brooklyn

Research, teaching and other projects have exposed Michael A. Joseph, M.P.H. ’96, Ph.D., to Zimbabwean health crises, the Bedford-Stuyvesant–Crown Heights AIDS epidemic and tuberculosis (TB) affliction in South African provinces. No matter where he has traveled, however, he has always returned to SUNY Downstate Medical Center in Brooklyn, where his interest in public health began.

Joseph’s wide-ranging path wasn’t what he’d imagined growing up in Brooklyn. Although he had planned to become a doctor, the premed courses at Brooklyn College turned him away from medicine. He switched his major to health science and secured an internship at Downstate. Assisting the late Rachel G. Fruchter, M.P.H., Ph.D., then-associate professor of obstetrics and gynecology, in researching gynecological cancers among minority and immigrant women, he said, “allowed me as an undergraduate to see a research project from inception to completion.” It also connected him to the institution that would become his professional touchstone.

“By my second epi course, I fell in love with the hands-on detective work linking an exposure to a health outcome,” recalled Joseph, who was encouraged by professors to pursue an M.P.H. At the School of Public Health he served as a teaching assistant during his second year, where his love affair with teaching began and spurred him toward a Ph.D. Joseph’s master’s thesis was based on his analysis of Fruchter’s data.

For his doctoral work, he went to the University of Michigan and assisted in the teaching of master’s-level biostatistics and epidemiology courses. There, he said, “I was trained by the best of the best in epidemiology: Siobán Harlow, Sherman James and David Schottenfeld.” He continued exploring a theme from his Downstate internship—minority health—for his dissertation, “Risk Factors for Lower Urinary Tract Symptoms in African-American Men.”

Strong family ties lured Joseph back to Brooklyn after he had completed his doctorate and was looking for a faculty position. When he heard about Downstate’s new public health graduate program emphasizing urban and immigrant health—a marriage of the themes that have guided his career—it seemed like a natural fit. “At a well-established public health school, I’d have less input, less room for innovation and growth,” he reasoned. “This was an opportunity to serve as a role model for a diverse student population.” Joseph’s lectures explore factors “prohibiting minority and underserved populations from engaging in healthy behaviors—including economic inequality, lack of employment opportunity, poverty and our failing health care system.”

Dedicated to both teaching and minority health, Joseph was invited on three occasions to teach an intensive biostatistics and epidemiology course to public health students at the University of Zimbabwe in Harare. “Africa is plagued by many infectious diseases, so students are in the field tackling outbreaks. What I teach here over 14 weeks, I had to teach there in two, from 9 to 5 daily. It was exhausting but quite fulfilling,” he said. Through Downstate’s HIV Center for Women and Children, he was invited in 2008 to train HIV and TB researchers at South Africa’s University of the Free State in Bloemfontein. “They had a wealth of data but needed assistance carrying out the next steps—conducting appropriate analysis or writing a manuscript for publication.”

An assistant professor of epidemiology, Joseph is the junior principal investigator on a grant from the Centers for Disease Control and Prevention, in which Downstate faculty collaborate with the Arthur Ashe Institute for Urban Health to target sexual behaviors that put heterosexual African-American men at risk for HIV infection. In 2006, Joseph and his wife-to-be, Lauretta Ansah, used funding from the National Black Leadership Commission on AIDS to support a ministry to educate the members of Bedford Central Presbyterian Church about the disease. “For years, the black church was silent about the AIDS epidemic because of stigma. Many in the black community still believe it’s largely a homosexual disease,” said Joseph.

Joseph always reaches out to peers. At Michigan, he mentored several students, including members of the Public Health Students of African Descent, a student-run group that was established over 21 years ago. He tutored master’s-level students struggling with epidemiology or biostatistics. He also co-founded the Black Young Professionals’ Public Health Network, also known as ‘The NETWORK.’ The NETWORK presents such programs for black attendees at American Public Health Association conferences as “Is Hip Hop Healthy for African American Females?” Poster sessions showcase research in health disparities by minority public health students and young professionals.

To Pascal J. Imperato, M.D., M.P.H., dean and Distinguished Service Professor of Downstate’s Graduate Program in Public Health, “Michael is extremely skilled in teaching epidemiological concepts [so that students are] engaged and encouraged to reach beyond their own perceived limits. His introductory epidemiology course is one of the most popular in the graduate program.” Joseph’s students consistently give him top ratings as teacher, mentor and role model.

After interviewing at Downstate in 2004, Joseph remembers thinking, “They loved me, I loved them, it’s a great fit.” For his work there, he was inducted into Delta Omega, the public health honorary society. Michael Joseph knows he’s in the right place.

—Carol Milano


			Originally published in Yale Medicine, Spring 2009. Copyright © 2009 Yale University School of Medicine. All rights reserved.