Serving the underserved: Experience gained from Pakistan to ENC helps honored professor improve access to psychiatry
Sunday, June 23, 2019
Dr. Sy Atezaz Saeed has devoted his life and career to caring for those less fortunate.
His focus is on those isolated from proper medical care — either because of geography or economics. Inspired by many communities in rural eastern North Carolina, he created a pathway for patients to connect to doctors via technology to get desperately needed help — regardless of their ability to pay.
Because of his devotion to serving the underserved, he was granted the O. Max Gardner Award in May by the University of North Carolina system’s Board of Governors, which esteems those who have “made the greatest contribution to the welfare of the human race.”
The annual award, established 1947, is the the highest honor the UNC System bestows on faculty from its 17 campuses. The winner receives a $30,000 stipend.
Saeed has served as chair of the Department of Psychiatry and Behavioral Medicine at the Brody School of Medicine at East Carolina University since 2004. He is the ninth ECU faculty member to receive the award.
He is also director of the ECU Center for Telepsychiatry and e-Behavioral Health, and the founding director of the North Carolina Statewide Telepsychiatry Program (NC-Step) and Chief of Psychiatry at Vidant Medical Center.
“Most, if not all, of my career has been focused on how to provide the best care to people who need it,” he said during an interview earlier this month.
Saeed grew up on the outskirts Peshawar, Pakistan, a city of almost 2 million people, located 100 miles from the border of Afghanistan.
In Peshawar, “there is a huge hospital and a big university,” he said. “But if you drive a half-hour in any direction, you find yourself in an area which is very underserved.
“One hour outside Peshawar, you find yourself in a tribal area between Pakistan and Afghanistan — which is not governed by anyone,” he added. “So seeing people with problems with access, not being able to afford care, and not being able to find it — is something I am familiar with.”
Academics and intelligence provided the pathway for Saeed to escape the poverty of where he grew up.
He graduated from DOW Medical College in 1982 (a public medical school in Pakistan), and initially focused on family medicine in his home country.
As he met with patients, he became more and more interested in mental health.
“A lot of people come in not necessarily saying, ‘I have anxiety and depression.’ But you figure it out real quickly,” Saeed said.
One in five people who visit their family physician have a diagnosable, treatable psychiatric illness, he added.
Primary care physicians have about 10 minutes with a patient, he explained.
“The patient doesn’t want to bring up [anxiety or depression] in the first eight minutes. So care, many times, is less than adequate. I wanted to spend more time and be more focused on patient’s mental health,” he said.
Saeed came to America to do his post-graduate work at Illinois State Psychiatric Institute in Chicago.
At first, he planned to return to Pakistan.
“What drives me are two themes — to take care of the people not being served, and to provide the best care,” he said. While living in America, he recognized underserved areas are universal.
“You look around and see that need is all over,” he said.
Has not been back to Pakistan since 1998.
Before coming to America, he was working in an underserved community, in a different province than where he grew up, when the Soviets invaded Afghanistan.
“I actually saw a lot of refugees coming from Afghanistan to Pakistan and I was right in the middle of that,” he said.
“I saw stark differences. I saw extremely wealthy people running away from Afghanistan because of the warlords. I had not seen before the custom-designed Mercedes that were being driven in that province and the mansions that were being built. But the vast majority of the people I saw were extremely poor — I saw little children actually begging by the side of the road for food,” he added.
“Those differences were just beginning. Pakistan has been under siege and war ever since. There are people who have grown up there, now in their 30s and 40s, that have never seen peace,” he said.
Before coming to ECU, he served as professor and chairman in the Department of Psychiatry and Behavioral Medicine at the University of Illinois College of Medicine at Peoria from 1995-2004.
He met his wife Janel when he was in residency school in Indiana. They married in 1991 and have four children — a 26-year-old son, Zackariah, who has Down syndrome, and three daughters. The youngest, Natalie, will attend John Paul II High School in the fall.
Sophia, a rising senior at ECU, is earning a degree in public health. She plans to go to graduate school and work with underserved populations. The oldest daughter, Karen, recently graduated from UNC. She will attend Wake Forest law school this fall, and also plans to work with the underserved.
“We are very proud they all have this to approach to human rights and taking care of people,” Saeed said.
His children have never visited his homeland because of the unrest and busy lifestyles.
One of the biggest problems he sees in medicine is when care people are receiving is not consistent with what has been proven to be the best.
“That is theme number one of all my career — to look at what evidence of how to best care for people,” he continued. “The second is the maldistribution of a physician workforce.
“Out of 100 counties in North Carolina, 31 have no psychiatrist,” he said. “Fifty-eight have no mental health provider. Over 80 percent are considered, by Federal guidelines as ‘mental health workforce-short areas.’”
These two factors — workforce scarcity and people not recieving the best care — are what led Saeed to develop the telepsychiatry program.
“If you can’t take providers physically to a location, telepsych is the next best option,” he added.
At hospitals, NC-Step serves people who come to the emergency department needing psychiatric help.
“Out of 108 hospitals in North Carolina, only 58 have a psychiatrist,” Saeed said.
NC-Step serves provides telepsychiatry in 60 hospitals across the state.
“I can log in to a web portal and go into the health record of the patient — just as if I were there,” he added. He then “sees” a patient via technology.
NC-Step also provides telepsychiatry in seven clinical sites. Six are in eastern North Carolina, one is in Macon County.
“Our goal is to have 20 or 30 such sites,” he added.
“We want our providers as close in geographical proximity to the patient as possible. They know the availability of local resources and we can then link them,” he added. “We also want them culturally as close to the patient as possible.”
Saeed said sometimes it is difficult being in the spotlight for his life’s work.
“I’ve lived my life mostly in the mode of serving. The first time I was nominated for [the Max O. Gardner Award] I said, ‘Seriously, really? You think that is me?’ Being the focus of that is flattering and humbling,” he said. “The more people that know about the work is a good thing.”
Saeed said he came to ECU when mental health was being reformed in the state. He saw an opportunity to serve.
“What brought me here was the same reason many psychiatrists were leaving. I saw I could replicate some of the things I was doing [in Illinois],” Saeed said.
Because of the reform, many ended up on the street without care, he said.
“The telepsych program actually was created to fix the problem of people showing up the emergency department because they had no other place to go,” he said.
In 2013, the year the program started, 162,000 people showed up in emergency departments across the state with mental heath crisis — twice the national average.
“When a patient shows up at the ED, they get care whether they can pay or not. If you show up for care at a clinic and can’t afford it, you don’t get it,” he explained.
The NC-Step program is in its sixth year.
“Less than 15 percent of our patients have private insurance and 32.8 percent of our patients have no insurance — and more than 50 percent have Medicaid and Medicare,” he said.
But the program works by bringing different components together, he said.
The program he created exists to serve any and all who need mental health care, no matter if they can pay or not.
“We won’t partner with anyone that is only for-profit and only takes insured patients,” he said.