The sky was astonishingly blue. The letter “y” carved
in the sky by the white smoke of the dislocated space shuttle
Challenger was reflected in the dark pupils of Tara. She was
4 years old and lying in a bed at North Shore University Hospital
in Manhasset, Long Island, New York. By her hospital bed, as
she was most days, was Savita Pahwa, M.D., now staring in shock
at the television screen. It was a long journey that brought
Savita from her home in India to the bedside of a child whose
illness would become her life’s work.
Her own youth in New Delhi was filled with the
excitement of tombola (local bingo), the rigors of a convent
the dream to one day become a doctor and do research in America.
Her father was an army cardiologist whose universe was an India
still under the legacy of the British Empire. Young Savita
surprised the family when she packed a bag for Kabul, Afghanistan,
the ECFMG, the test that opens the door to American medical
training programs. It was the first time that she saw snow
and her first
victory, as she passed her exam.
Savita chose Kings County Hospital Center in
Brooklyn as the site for her training program in pediatrics.
In spite of the
extraordinarily challenging environment of the county hospital,
she encountered her first mentor, Elizabeth Smithwick, M.D.,
who took her under her wing to train with world-renowned
immunologist Robert Good, M.D., Ph.D., D.Sc., at Memorial Sloan-Kettering
Cancer Center, one of the bastions of American cancer academia.
Physician husband Raj moved from England to the United States
to continue his training and subsequently ended up at Sloan-Kettering
doing bone marrow transplantation; he helped Savita and her
team treat children with severe combined immune deficiency.
eight years of clinical and research immunology, Savita left
the cancer hall of fame to become chief of pediatric allergy
and immunology at North Shore University Hospital.
Already knowing the best medicine is learned
from your patients, she was ready for the new challenge of
encountering the first
child with acquired immune deficiency. The children would
typically present with very large lymph nodes in their neck
and failure to thrive. Recurrent bacterial infections would
limit their survival to 4 to 5 years of age. It would be
the work supported
by a pediatric AIDS clinical trial program in which UM’s
Gwendolyn Scott, M.D., among others, played a big role that would
lead to the use of AZT to reduce mother-to-child transmission
of the deadly virus. While at North Shore, Savita would partner
with infectious disease specialist Mark Kaplan, M.D., and help
collect and study samples used by Robert Gallo, M.D., at the
National Institutes of Health that would lead to the discovery
of the AIDS virus. She would also identify immune defects in
children with the virus and see the miracles of new treatments
allowing children to survive.
Savita received a call from UM’s Eckhard Podack, M.D., Ph.D., asking her
to join the team in its fight against AIDS. With his enigmatic voice he challenged
Savita to obtain a Center for AIDS Research (CFAR) grant from the NIH within
three years. “By the way, many people have tried before you,” he
said, “and all five trials thus far have been unsuccessful.”
To prepare for the challenge, Susan Plaeger,
Ph.D., Janet Young, Ph.D., and Ann Namkung, M.P.H., were instrumental
in advising Savita and getting
a study section at the NIH, reviewing the CFAR grants to help select
those that would receive funding across the United States.
The advocacy role
that NIH personnel
such as Susan, Janet, and Ann play is never mentioned enough—these are
the unsung heroes who are often responsible for making science possible across
the nation and the world.
Once at UM, Savita quickly rallied individuals
who had done remarkable work in the AIDS domain, too often
in isolation. Her quiet demeanor,
and brilliant intelligence were the tools she used to break down skepticism
division among the groups. In 2005 Savita submitted the first CFAR
application, which was deemed in the very good range, but not
fundable. But Savita
is not a quitter; she remembered the lessons she learned from her parents
long road to Afghanistan to take the ECFMG test. She and her team did
to do, looking at the criticisms and addressing them one by one.
Savita does not like attention. She wants to
be sure we all understand the work was done by her colleagues—she was simply bringing people together. Among
the critiques, one reviewer wrote: She has been there less than a year—how
could she possibly know the people at the University of Miami? Well, that is
what Savita does best: learning to know people. Margaret Fischl, M.D., Gwendolyn
Scott, M.D., Gail Shor-Posner, Ph.D., Lisa Metsch, Ph.D., Andreas Baur, M.D.,
and Neil Schneiderman, Ph.D., were the people Savita learned to know and work
with to accomplish what had never been done at the University of Miami: getting
a CFAR grant funded. Many others, such as Richard Bookman, Ph.D., gave their
time and advice relentlessly.
When asked if she still carries the lessons
learned from little Tara in the bed at North Shore with her
to this day, she answers, “I learned more from
the children I took care of than from anyone else in the world.”
Tara eventually developed a strange form of
chicken pox, actually the first acyclovir resistant varicella
case ever described in
of the AIDS virus ravaging her small body. Encephalitis would
follow and lead to her death.
It is so hard to understand the absurdity of
the death of a child like beautiful Tara, with her big smile
and trusting dark eyes.
a difference against this dreadful epidemic would never have
happened without her contribution.
So we’ll remember her, watching the explosion of the shuttle on a television
screen with perplexed eyes, her chin perched on top of her emaciated wrists.
We’ll remember all of those who, like Savita Pahwa, took the long road
to America. We will remember the kindness and generosity of our people in America
who welcomed those who arrived often exhausted, but ready to contribute.
One day when the AIDS epidemic is remembered
as a nightmare of the past, special note will be made of what
erasing HIV from
the human species
here at home and everywhere in the world. Our congratulations
to the CFAR team!
This article is the first in a series by Dean
Pascal J. Goldschmidt, M.D., that will appear in this magazine
saluting the work
of scientists and physicians
the Miller School of Medicine.