Interview with Stuart Brink

Stuart Brink about it's Honorary Citizenship Certificate and it's work within ISPAD

Here are some answers to the queries posed and which resulted in the "surprise" honor of the Mayor of Timisoara, Romania presenting me an Honorary Citizenship Certificate at the Timisoara Philharmonic Hall and opening ceremonies of the Pediatric Endocrinology of Romania Congress with a beautiful silver medallion on the occasion of my May 2016 22nd annual return visit to Romania. This is a journey inspired when I was originally ISGD's and then ISPAD Secretary-General and learning from my good friends and mentors, Professors Bruno Weber and Zvi Laron, who taught me the joys and the importance of being a teacher and travelling to bring updated information about pediatric and adolescent diabetes to other parts of the world. Both spent their entire professional careers doing such teaching, opening up doors and opportunities for collaboration, inviting people to join ISGD and ISPAD, serving as officers and inviting friendships to develop and flourish across borders and at the same time promoting high standards of diabetes care and fostering ongoing concepts of optimizing care to the patient and family.  It was easy to accept these ideas since they were quite similar to my own when I started as the first staff pediatrician at the Joslin Clinic, developed its youth program with a multidisciplinary team, and did research clinically as well as in cooperation with scientists in the laboratory like George Eisenbarth, Stu Soeldner, Sri Srikanta and eventually served as a co-investigator helping to create and carry out the DCCT with colleagues like David Nathan, John Godine, Larry Rand, Dorothy Becker, Alan Drash, Neil White, Bill Tamborlane, Lester Baker, Don Etzwiler, Lois Jovanovic, Jerry Palmer, Saul Genuth and especially Oscar Crofford but many others. My teaching efforts continued at both Harvard Medical School and Tufts University School of Medicine as well as NEDEC, the New England Diabetes and Endocrinology Center, where I currently work as Senior Endocrinologist.


As so many of us helped move ISGD to ISPAD, and as Bruno Weber, then President, and I as Secretary-General, wrote the Declaration of Kos one late evening in Greece, we presented this educational mission vision to ISPAD members at the annual meeting with enthusiastic and universal acceptance.  A key provision of this Declaration of Kos was our vision as a mechanism for promoting eagerness to teach and expand the knowledge about diabetes around the world, not just in North America and Europe but especially to places where this information was lacking or limited by political or economic circumstances. We began to promote ISPAD PostGraduate conferences and set out to expand with wonderful financial assistance and sponsorship from many pharmaceutical and medical device companies to bring ISPAD speakers to Eastern Europe, Asia, Latin America, the Middle East and Caribbean as well as Latin America. This brought more opportunities for us as ISPAD leaders to teach and also brought more involvement of other ISPAD colleagues and friends to join us in promoting, planning and carrying out such programs. I have taught also with Harry Dorchy for many formative years at the Serban Center in Romania and his efforts deserve special mention as an exemplar of such experiences. I have taught or co-taught with more than 150 of ISGD/ISPAD members and appreciate everyone's excellence and passion, tremendous experience and enormous fund of knowledge as well as special friendships for so many years in these teaching efforts. The ISPAD Lestradet Lecture that I presented in 2011 as one of the highlights of my involvement with ISPAD and summarized much of what I have learned and tried to accomplish as an ISGD/ISPAD member.

I have now traveled to 60 countries around the world involved in such programs, co-sponsored by local medical societies and universities, and more recently also by IDF and Life for a Child programs as well as CDIC initiatives.  Clinical care, technology innovations and new insulins, psychosocial aspects of diabetes and diabetes education as well as basic science vis-à-vis epidemiology, prevention and transplantation have all been part of the topics presented. In some cases, combined programs with pediatric and adolescent endocrinology took place as well as diabetes while in others, the focus on diabetes was key depending upon need and interest of the audience and speakers.  The goal was always the same, sharing information, updating information, bringing colleagues together to become friends and to promote relationships at the same time serving as a focus for younger physicians and scientists in training positions as well as those already established in the clinical and academic realm in their countries.  We have had tremendous success in bringing in such colleagues to ISPAD, fostering such relationships and some of our best friendships have been created through such PostGraduate programs. 


In Romania, specifically, the programs started with Professor Ioana Micle and Professor Viorel Serban and then brought in more and more Romanian specialists working with children and adolescent with diabetes all around the country, fostered the development of Romanian pediatric endocrinology and diabetology as valid subspecialties recognized by the Deans and Rectors academically and by the health care systems throughout the country.  More recently, this has been led with an annual mini-textbook update co-edited and organized by Professors Iulian Velea and Corina Paul with continued active participation by an increasingly active core group of Romanian physicians each year.  We have become good friends, have celebrated and danced together and have witnessed enormous progress with introduction of new insulin analogs, insulin pumps, attention to other endocrine issues and not just diabetes and multidisciplinary approaches improving clinical care, research as well as reducing short and long term diabetes associated complications and watched the better documentation of these efforts concurrently. 


The same model has been applied with the CDIC and LFAC programs helping to bring multidisciplinary education and new ideas as well as insulin and supplies for monitoring to less fortunate parts of the world where infrastructure was absent or limited because of financial restraints.  The Diabetes in Children and Adolescents CDIC free training manual that I wrote and edited with ISPAD colleagues, Warren Lee and Kuben Pillay, came to fruition as part of the ISPAD PostGraduate educational initiatives focusing on the clinical and training/education needs in Africa, Asia and Latin America. This manual written in English and available as a free PDF on the ISPAD and other websites has been translated into French and soon will also be available in Hindi as well as Spanish versions with the assistance of ISPAD members and their local teams with such translation.  An educational slide set (English and French) is also freely available on the ISPAD and other websites with this same information. I been humbled to witness its use in Mexico, Bolivia, Bangladesh, Tanzania, Uganda and China and received many compliments on what we included as promoters of such improved care for children.  Efforts to get ISPAD involved with on-line free educational seminars has been more difficult beyond the initial dozen free powerpoint presentations and videos that we prepared several years ago but more recent discussions suggest that these may be resurrected in coming years with the efforts of current ISPAD leadership in coordination with other international societies.


The presentation of the Timisoara Silver City Medallion and the Timisoara Cetatean de Onoare initiated by Drs Velea and Paul in May 2016 at the Opening Philharmonic Ceremony of the Annual Romanian Pediatric Endocrinology Congress was a terrific honor, witnessed by  Professors Martin Savage, Ciril Krzisnik and Ze'ev Hochberg and all this serves to continue the needed impetus to promote ongoing PostGraduate ISPAD courses by as many ISPAD members as we can urge to volunteer, to participate and to promote such important endeavors. This spread the word about the importance of diabetes education for the patient and family, the importance of promoting mechanisms for allowing optimal treatment and self-monitoring as well as mechanisms for advancing research and technology, continuing multidisciplinary education and psychosocial support that is so critical for a chronic illness like diabetes, using diabetes as a model for other chronic illnesses and improving the health and well being of children and teenagers around the world.  Still much needs to be continued and to be done. 



The challenge for ISPAD and its active membership is to use such models to spread the word and the message of fulfilling the need academically, politically and psychosocially. These efforts continue to help fulfill the goals of the ISPAD Declaration of Kos that we wrote on September 4, 1993 in Greece at the annual ISPAD meeting that year.  We added the Declaration of Kos to the CDIC training manual since its relevance continues.  If anyone would like their own copy of the signed Declaration, please send me an e-mail and I will send one back as an attached file that can be printed and placed  in your office, clinic or hospital for all to see that our work is continuing.   

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