Healthcare, etc.: Dr. Alina Popa: A Role Model

Alina Popa, M.D.

The people were meant to be cut off from the outside world, but her parents had a “smuggled-in” short-wave radio and they sometimes found the “Voice of America” broadcasts. If you were caught listening to such "propaganda" you were a dissident and were forced into hard labor or even killed.

A year before the violent 1989 Romanian revolution a sympathetic member of the KGB went a step further and “sneaked” the small family a color TV from West Germany. Thirteen-year-old Alina saw Jim Henson’s Muppets for the first time; her “mouth dropped” as she was “mesmerized.”

She was able to go beyond the Russian literature that had been available and read American works including, she told me with excitement, "Gone With the Wind,” the saga of one woman’s struggle for survival. She learned about John F. Kennedy and his soaring dreams; how he promised to send men to the moon "before the end of the decade" (with the help, we now know, of Katherine Johnson’s mathematical skills), and it happened. Alina just idolized him.

And she came to “love” American culture. She saw that there was something better outside of stifling Communist Romania. Not perfect, but better. And she saw that there could be freedom to be who you really are, freedom to be who you want to become.

Buzz Aldrin and the Lunar Module on the moon;
July 20, 1969 (NASA)

“As a child, you don’t know what you don’t know,” said Dr. Popa, infectious disease specialist, and full-time teaching attending at York Hospital, as we sat and talked. But the innocence of childhood passes. Even as a young teenager, she was aware that things around her were not as they should be.

“It was a tough life," she said. "We learned how to shut our mouths and never say a word (against the government). Not even to your neighbors, friends, or relatives. You didn’t know who might betray you. We almost never talked about it at home, and when you spoke in the house you whispered because you didn’t know what the walls contained. Outside of the house, (the Romanian President) Ceauşescu is your father. You love him and adore him.”

Listening intently, it was I who was mesmerized (and shocked). “Were you afraid?“ I wondered.

“No. I was angry and outraged. Knowing that this is not how human beings are treated,” she said. Yet, somehow, she could deal with it, she told me. What she could not deal with was the lack of electricity, the lack of water, the lack of heat, and, especially, the lack of food. The utter starvation.

There was rationing of sugar, flour, eggs, bread, milk, and whatever. You had to stand in line and wait for hours for your turn. But the shelves in the stores in Bucharest were often completely empty. “After a while,” she said, ”you don’t feel hunger anymore. When you are always starving your stomach shrinks.”

Waiting patiently for food in Bucharest in the 1980s
(by Andrei Pandele)

The long winters were particularly “brutal.” It was terribly cold, the water pipes froze, and fresh food was scarce. It was the same diet week after week, month after dark month. “The only fruit was apples, and the only vegetables were potatoes... and pickles,” said Dr. Popa.

There might be some pig fat (with no meat on it) and “stinky feta cheese” (kept on the outside balcony). Sneaking a bit of cooked meat, even in the countryside away from the city, could mean death if the (nosey) neighbors got a whiff of it and called the Securitate, the ruthless Romanian secret police.

Summer on her grandmother’s farm was a little better, Alina informed me, with more fresh fruit and vegetables, but she was still usually hungry.

“It toughens you up. You don’t realize that your childhood is gone,” she remarked. While being forced by the harsh circumstances to grow strong emotionally and mentally she also shot up in height, and her pants and skirts were “always too short.”

Her parents were underpaid engineers in the large state petroleum industry. They were overwhelmed by too much work and by having too little money. You see, as educated people in a communist society, they were the feared “intellectuals.” People who think for themselves. They could not be brainwashed “to act like sheep.” So the system oppressed them to suppress them...and to try to break them.

Alina sensed early that education was a way out. She was determined to find something better for herself and she worked hard; she knew what she had to do. At 14 she passed the difficult exam to get into “the best high school in the country.” She did her homework by candlelight and her vision was permanently affected as a result. She was drawn to the sciences and had a special feel for mathematics. In fact, she was headed for a career in math. That is, until something happened.

At 15 she got “super, super sick.” It was summertime, and she went to the mountains with her father. She loved hiking with him and she was delighted to be in nature and free. But the weather suddenly changed (as I know it can in the mountains) and following the chilly hike she became ill with fever and congestion, maybe “strep pneumonia” (as she reflects on it now).

Hiking in the Carpathian mountains in Romania
(Mihai Constantener)

There was no money for her to see a doctor, and her condition steadily worsened. Her right eye became red and swollen. She became increasingly lethargic. Then unarousable. Her eye was (literally) “popping out.”

Her frightened parents rushed her to the hospital where she had “signs of meningitis” as she had orbital cellulitis (an infection behind the eye, probably spreading from sinusitis).

Alina was admitted to the pediatric ward but she was already a lanky 5’9” and there was no kiddie bed big enough to cradle her. One of the doctors gave up his own sack so her feet didn’t hang unceremoniously over the end of the mattress.

She rested and was on antibiotics for three weeks, and they saved her vision. But while she was in the hospital something else occurred; she “fell in love” with medicine. She liked the smell of the hospital, she liked the cleanliness, she liked the food. She said she “just loved it.” She talked with the nurses and the doctors and asked them lots of questions “all the time.” She made up her mind on the spot and boldly told her cautious parents that she wanted to become a doctor.

So, in the tenth grade, Alina changed her course of study from math and “heavy-duty” physics to biology and chemistry. The chemistry came naturally; it was all logical (”you count”). But “memorizing” (non-logical and messy) biology was a “struggle.” Dr. Popa is proud of her accomplishment, however, as she finished near the top of her large class.

She then began six years of medical studies (three years of theory followed by three clinical years) at the prestigious (and international) Carol Davila University of Medicine and Pharmacy in Bucharest.

Students hard at work in the ornate Carol Davila library
in Bucharest (from Euroeducation.net)

But by the time she was 20 she became disillusioned with what she was seeing in the Romanian hospitals. Communism was gone, yes, but there was still incompetence, greediness, overt corruption, and misogyny. This was clearly not what she was dreaming about, not as the daughter of “fair and honest people who were not willing to be greedy and sell out.”

The border was open now. If you could speak English and pass the standard “Step 1” and “Step 2” exams you could practice medicine in the U.S. So Alina decided to learn the “difficult” language (with unusual spelling and “a lot of “nuance”) and take the required tests.

But there was no money. Not for the exam fees. Not for an English tutor. And not for the (anticipated) airplane fare to the land of liberty, to America. What to do?

Her father knew his daughter’s goals, and he reassured her. He calmly told her that his grandmother had left him a valuable piece of land in the foothills of the mountains; the mountains where Alina became ill and found her calling. He would happily sell the property and give her the proceeds, more money than he could ever make himself. There was never a doubt about what to do; her parents, she noted, were completely selfless.

So Alina bought second-hand books and studied intensely (she “ate them alive”) for the exams. And she learned English. Not with an expensive tutor, but by herself. With the fall of communism, she could listen freely to American music on MTV (when that was hip) and VH1 (for the slightly less cool). She learned how to pronounce the words by listening to music on the bus. (Probably not the best way to pick up on “nuance.”)

Dr. Popa paused and told me that her father passed away three years ago (her mother still lives in Bucharest). She cried as she recalled his memory, and his love for her, even as he reluctantly but generously let her go. As he let her go to find herself.

Anyway, she had to leave Romania briefly to go to Budapest for the Step tests. It was her first real travel experience. The city was “so beautiful” she told me. Bucharest had similar beauty once, “like little Paris,” she said. But much of the historic district filled with many homes, churches, and synagogues, was destroyed by the monstrous Ceauşescu “out of hate for religion” to build his €3-billion Palace of the People.

The grandiose administrative "Palace of the People"
in Bucharest (from Rick Steves)

Alina was anxious to finish medical school and leave the place that caused her so much pain. She was one of many who simply had to escape. Four million hurt people left, most of them for other parts of Europe, many for the New World.

I wanted to know how Dr. Popa and her well-mannered six-year-old son Gabriel came to be sitting together with me in my living room in York, Pennsylvania, rather than somewhere else in the country.

Alina left Bucharest behind and came to the U.S. in 2000. She had arranged for several interviews for a residency in internal medicine. The first was in Chicago at St. Joseph’s Hospital (with Northwestern), on Lake Shore Drive. It went well, and they offered her a three-year position before the “match.” She quickly accepted.

Dr. Roberta Luskin-Hawk

It was at the Catholic hospital overlooking Lake Michigan, while interacting with students, that she discovered that she “loved teaching.” She knew “from that moment on” that she wanted to teach (a second unexpected calling). One of the attendings she most admired and “loved” was Dr. Roberta Luskin-Hawk, a prominent infectious disease specialist who, she said, “believed” in her.

(Alina had been attracted to microbiology in medical school because “the Latin names [of the bugs] came naturally” to a native speaker of Romanian, “a Romance language.”)

Through watching and emulating Dr. Luskin-Hawk, Alina learned how to treat patients with one of the most feared infectious diseases of our time, HIV. She took care of Chicago’s stricken gay community and the area's mostly-poor injection-drug users. (In Communist Romania there were no gay individuals at all, she noted, without a hint of irony.)

After bitterly-cold Chicago, she applied “all over” for a fellowship in infectious disease. She landed in warm sunny Miami at Jackson Memorial Hospital for two years of study (on a J-1 “exchange visitor” visa). It was there that she met the “beautiful” and “damn smart” Jamaican-born physician, (and second special role model) Dr. Lorraine Dowdy.

Since Jackson was a regional referral center Dr. Popa saw complex cases involving immune-suppressed transplant recipients from across the South and HIV patients from the Caribbean, mostly migrants from Haiti and the Dominican Republic.

On her “awful” visa she needed to take a so-called “waiver” job after her fellowship. That usually meant working in primary care for an underserved population or in an underserved area (“where nobody wants to go”) for three years before being allowed to apply for permanent resident status.

She was quite happy in 2005 when they informed her that she could satisfy the requirement by practicing in her specialty of infectious diseases in the under-resourced and impoverished downtown area of York. She was made the medical director of the York County Health Center. This is supported by federal funds from the Ryan White (CARE) Act of 1990 (co-sponsored by Senators Edward Kennedy and Orrin Hatch--when working together across the aisle was doable and appreciated) that provides community-based grants for direct HIV services.

While at the Center she took care of many patients with HIV (thankfully, a generally manageable disease now) and many individuals with hepatitis C (95% curable). Dr. Popa also worked at Family First Health in the city and she taught residents from the York Hospital programs and medical students from Penn State and Drexel. She showed, yes, showed, them how to understand and navigate the specific and difficult challenges of caring for the underprivileged.

Poverty and HIV (CDC Data from 2007)

(The risk of HIV infection through sexual contact can be reduced by more than 90% by use of the pre-exposure prophylaxis-or PrEP-antiviral drug Truvada. The monthly cost for this in the U.S. is $2,000 but only $8 in Australia. But as of June 2019, commercially insured individuals can receive it at no cost under the Affordable Care Act. It is currently underused.)

Shortly after receiving her cherished Green Card in 2011 Alina received a call from Dr. Kevin Muzzio at York. He was aware of her efforts in town and he told her that there was an unexpected opening for a full-time teaching position at the hospital. She eagerly accepted the offer, and she has been at WellSpan since 2012.

The root of the word "doctor" is the Latin "docēre" or "to teach." And the essence of teaching is communication. Dr. Popa strives to connect with her students and residents and inspire them to develop the skills of critical thinking, careful analysis, and proper weighing of clinical data. And how to apply this to compassionate and individualized patient care. She hopes to serve as a role model for the next generation of physicians.

As Schwenck and Whitman (1987) have said:

Patients feel that the most important characteristics of a physician that lead to high patient satisfaction are knowledge, understanding, interest, sympathy, and encouragement. These equally worthy qualities of an excellent teacher lead to high learner satisfaction.

With this academic position (no long nights at the hospital), she has enough time to be an attentive mother too.

(You see, I first met Alina at our JCC pool when I looked up from an especially slow lap and saw her gently and calmly interacting with Gabriel. I sensed that she was a physician and I took a chance, got out of the water, and introduced myself. I guess I recognized a doctor’s manner. I don’t understand how I knew this, but I just did.)

Gabe’s half-brother, Edward, by Dr. Popa’s brief first marriage, is 15. Dr. Popa was busy and had been single for a while when she met her current husband, a Romanian physician, here in York through a mutual colleague. They are very happy, and she believes that “after 20 years” she belongs here.

(The interview was over and Alina was preparing to leave with her son [I think he was tired of patiently waiting] when she stopped and softly confided in me that she was “a little bit Jewish, too.” Her maternal great grandmother had escaped the Nazis in Transylvania. She married a German and converted to Christianity, but she still baked “Jewish delicacies; breads and pastries.” I sometimes braid a challah for Shabbat, and hearing this nearly made me cry.)

Anyway, her harried residents have been known to exclaim: “Nothing fazes Dr. Popa.”

She admitted, yes, that she can “put up with a lot of stress” and "still have a smile" on her face.

Knowing her story, we can see why.

Reference:

Schwenck, Thomas L., M.D and Whitman, Neal A, Ed. D The Physician as Teacher. Williams & Wilkins, Baltimore, 1987, p.12.

Watching intently and learning: