Community profile: Birmingham, Alabama

For Kirk Thame, MD, Birmingham, Alabama, was a surprise in at least two ways. Born and bred in Kingston, Jamaica, the pediatric gastroenterologist was looking for a practice somewhere in the South to be near family members in Miami. “I didn’t expect Birmingham to look the way it does,” he says. “I expected a big, dirty city, a version of New York. But it actually has a pleasant, suburban feel, and the hospital itself (Children’s Health System) suited my needs in many ways.”

His second surprise was that he settled at all in what was once known as the Pittsburgh of the South. “I actually interviewed somewhere else first, but I scheduled an interview at Birmingham just to have a comparison. And I ended up staying.”

Thame had completed training at hospitals in Miami and St. Louis before returning to the University Hospital of the West Indies, part of the complex where he completed medical school. After six years, though, he made the decision to relocate for several reasons, he says. “There were frustrations in terms of limitations of living in a Third World country, including work attitudes and, what was worse, not having [needed equipment and other supplies].”

Founded in the parish house of All Saints Church in 1911 as “a charity institution for children alone,” Children’s is just right for Thame. “It’s a freestanding pediatric hospital,” he says. “You don’t have to fight adults in the trauma of going through [such steps as using] scanners, labs [and other equipment]. Everybody is child-friendly. It’s primarily clinical and not heavy-duty research, but there are research opportunities as well.” Not only that, but “the people I was coming to work with seemed to be excellent people, and that has turned out to be true.”

Children’s is the largest pediatric burn center in the Southeast, and it treats 95 percent of Alabama children diagnosed with cancer and other blood disorders and has the only pediatric bone marrow transplant program in the state. Its patient base extends into three neighboring states, and its Critical Care Transport Team mans mobile ICUs that pick up patients from towns and other hospitals throughout the state. In fact, says spokesman Kathy Bowers, “Our team has traveled literally around the whole country—using ground transportation, helicopters, and even jets. In 2008 alone, there were 1,004 transport cases, accounting for 181,032 miles.”

In a way, the city’s reputation from yesteryear hasn’t caught up with the reality of today, which is why newcomers may be surprised.

Steel-driven Alabama

Destined to become Alabama’s largest city, Birmingham was little more than a country backwater called Elyton until after the Civil War. Confederate forces had discovered they could produce guns and bullets there, thanks to an unusual (some say unique in all the world) confluence of the three main ingredients in steel production—iron ore, coal, and limestone. But bullets were small stuff compared to what would come. With no major river for commercial transportation, the town might have remained sleepy. But when cotton gin promoters learned that railroads had targeted the area as a major crossing point, they began selling lots nearby. On June 1, 1871, the town became a bona fide city. When steel became the wave of the future, Birmingham’s immense prosperity was guaranteed.

In fact, the rapid rise in the steel industry and resulting population growth inspired a nickname in the late 19th century, “The Magic City,” that sticks today, even though steel has become a minor part of the economy. It’s been replaced by such healthcare conglomerates as the University of Alabama Birmingham Health System, which includes a hospital, medical school, several satellite systems, and an astonishing research component. One “branch” is its Regional Biocontainment Laboratory with high-security labs for developing vaccines to combat some of the world’s most dangerous emerging infections, including those that could be used as terrorist weapons.

Among its multitude of other projects, UAB spokesmen say it’s become one of the nation’s top two or three brain cancer research centers. Among many accomplishments, its faculty discovered the origin of the HIV virus One off-the-beaten-track endeavor: breaking new ground in combating computer cybercrime around the world in partnership with the FBI, CIA, and Interpol.

Birmingham’s medical community

Businessman David Sher, says “UAB has just absolutely been our savior. It takes up 82 square blocks of the city and has a $3- to $4-million impact on the area.” As the state’s single largest employer, it’s responsible, directly or indirectly, for 56,000 jobs statewide with a $3.6 billion yearly impact. Part of the healthcare industry’s prosperity can actually be credited to the old steel industry, according to economist Mickey Gee. “Because we had such an industrial base, with strong unions, a lot of people have medical insurance,” he says.

Farrell Mendelsohn, MD, however, sees great advantage in the smaller setup at Princeton Baptist Medical Center, where he started the Center for Therapeutic Angiogenesis in 1999. With a staff of eight, he is currently conducting trials using a complex process in which specially treated adult stem cells are injected into selected sections of the heart, “coax-ing” the heart into building new blood vessels. Trial volunteers are “desperate cases” with no treatment alternatives left. Associated trials infusing stem cell combinations into patients’ leg arteries so far have shown that recipients could walk farther without cramping— and have had their risk of amputation cut in half.

Not stopping there, researchers at the Center are also working on “two very, very exciting things.” Mendelsohn says. By isolating and puting into an incubator stem cells from just one healthy young man in Cleveland, Mendelsohn’s team were able to multiply the cells “to the point that there are hundreds and thousands of doses available from this one individual.” In fact, the outcome has inspired formation of a new company to distribute them. And the angiogenesis lab is preparing to treat its first peripheral arteriosclerosis disease (PAD) patient with stem cells from the placenta of a patient in Israel, underscoring the international scope of today’s medical research.

In spite of some 10 or 15 sites in other settings around the country, Princeton Baptist became the busiest location for Mendelsohn’s trials. The reason: “We have something special here. We’re in a part of the world where cardiovascular disease is an epidemic.” That means a ready-made clientele of last-chance cases—and a happy chance for the born-and-bred Birminghamian researcher to return to his roots. He also likes working in a relatively small setting.

Baptist, he says, is “big enough to do advanced types of therapies and research protocols, but we’re not so big that we have to deal with the bureaucracy of an enormous place. We are so much faster and more efficient than a large academic center in getting our patients taken care of that you wouldn’t believe it.”

For example, “We get all of that stuff—eye exams, colonoscopies, and extensive screening— accomplished in a two-day period. When I’ve talked to my colleagues elsewhere, the idea of getting these folks ready in four to six weeks is mind-boggling to them.” One key reason: “We have an excellent relationship with the rest of the Baptist staff.”

Nevertheless, news of his work has spread far and wide. “Now we have teams from Israel, Korea, Japan, and all over the world flying here to collaborate with us in doing the research,” and the word is attracting patients from a greater and greater radius.

Not every Birmingham hospital incorporates research facilities, but each one has added cutting-edge techniques and equipment.

St. Vincent’s East is one of two training centers in the United States using Excimer Laser Ablation Therapy to remove leg vessel blockages and avoid amputation. It is also one of only two places where another technique is used. In this procedure, called CorMatrix ECM™, patients’ own cardiovascular tissues remodel themselves. St Vincent’s East’s two daVinci® Surgical System robots are consistently ranked in the top five busiest in the world for their prostatectomy surgeries. As part of Ascension Health, St. Vincent’s East is one of five facilities in the area.

Brookwood Medical Center, a Tenet Healthcare facility, recently became the official healthcare provider for the nearby Talladega Superspeedway, considered the “fastest, biggest, and most competitive motorsport facility in the world.” Among its special departments are its Digestive Disease Center and Advanced Wound Care Center for treating non-healing, chronic wounds.

Birmingham: Greener now

The healthy outdoor city environment has inspired a surging number of open-air activities from hiking and biking to canoeing on the nearby Cahaba River and just plain enjoying the trees, flowers, and greenery.

But it wasn’t always thus.

Longtime resident and historian Jim Baggett says he’s seen old pictures of cars in midday with headlights on to cut through city smog. The darkness at noon was caused by a combination of emissions from steel mills, coal-heated buildings, and automobile engines. “We still have issues with pollution,” he says, “but it’s a different kind, primarily from autos and not visible to the eye. Also, there’s not a lot of mass transit here [which would help reduce the CO2 accumulation even more].”

Dalton Smith, the president and CEO of the Birmingham Business Alliance (BBA), says a transformation has taken place in more recent years. With some pride, he says, “In summer, it’s exceptionally green, a color that’s hard to describe.”

Many outsiders don’t realize that the city is built at the southernmost tip of the Appalachian Mountains. Birmingham’s two most prominent, Red and Ruffner, boast large parks and nature preserves. The 1,108-acre Red Mountain Park, on land formerly owned by U.S. Steel will be located near the city’s long-time “mascot,” a 56-foot figure of Vulcan, the god of fire, originally installed as a monument to the steel industry. It’s the world’s largest cast-iron statue. On Ruffner Mountain, there’s a new nature center. After the city park in Portland, Oregon, it’s the nation’s largest urban nature preserve. The city’s current pride and joy, Railroad Park, is almost ready to be christened. Its 20 acres in the center of town replaces, not surprisingly, an old railroad “boneyard.” Says city spokeswoman Katherine Billmeier, “It’s the perfect spot between the ever-growing UAB campus and the downtown business district.” It will incorporate a lake, trails, an amphitheater, restaurants, and an open-air market emporium.

Adding Railroad Park to the mix across the city, Birmingham soon will be able to claim more green space per capita than any other American city, according to the mayor’s office of economic development.

Residents like Elizabeth Turnipseed, MD, like to talk about the remarkable outdoor opportunities. “One of the nice things,” Turnipseed says, “is that the areas surrounding the city are really beautiful with all of the hills. There’s wonderful hiking within really a few minutes and an outstanding mountain bike trail in one of the city parks called Oak Mountain. There are lakes; there are rivers. We’re four hours from the beach.”There’s also talk about “an enormous loop all around the city, creating a connected park circuit,” she says.

A unique fit

Although her family was from the South, Turnipseed, who is now the medical director for disease control at the Jefferson County Department of Health, was raised in the North and received a master’s degree from the Harvard School of Public Health. “Then I left in apparently one of the coldest winters in Boston in recorded history.” Her first destination: UAB for a medical degree and residency program, followed by the health department position. Her husband, a faculty member in the UAB cell biology department, agrees Birmingham was really a good fit.

According to Turnipseed, Birmingham is interesting “in that it’s not a university town. It’s bigger than that, but having the university keeps a dynamism here and keeps people from all over the country and all over the world coming here, bringing new ideas and discussions and tastes, keeping good restaurants and good art—all the things I think that make a community really livable.” She laughs when she thinks of friends who asked “if I was coming of my own free will. Those who have come to visit have been pleasantly surprised.” As for her and her husband, “We hope to stay. When we came, I didn’t know if it would be a short- or long-term decision, but it has clearly become a long-term decision.”

The transition from dirty industry to white-glove medical institutions, banking, and insurance dominance has proven to be “magic” for the city. Other manufacturing businesses have sprung up to produce hospital supplies and equipment, as well.

Historic resolve and resolution Several blocks from the new Railroad Park, another green block reminds residents and visitors of a much different time. It’s a reminder of justice triumphing in what was once America’s most segregated city. Kelly Ingram Park, named for a heroic firefighter, became the assembly ground for civil rights groups in the turbulent 1960s. Things came to a head with two events on adjacent streets that are almost permanently etched into the Birmingham psyche.

Ever since the 1930s, the city had been a cauldron of clashing ideologies. Union organizers bedeviled management. “Native-born” workers faced off against immigrant Catholics, and Socialists joined the fray. Birmingham, wrote historian Diane McWhorter, became “the Deep South headquarters of the American Communist Party,” which gained strength by championing the famed “Scottsboro Boys,” nine black hoboes convicted on trumped-up rape charges and jailed in the Magic City. As a result, the city “became the nerve center of the first southern working-class black movement.” A reawakened Ku Klux Klan became more and more active in response to the growing civil rights movement and the founding of several African-American organizations, such as the Southern Negro Youth Congress.

In 1956, young Autherine Lucy briefly integrated the University of Alabama in Tuscaloosa but was forced out after a student fomented a riot. Other blacks came back for good a few years later. A local civil rights leader, the Rev. Fred Shuttlesworth began to gain national prominence and so did one Theophilus Eugene “Bull” Connor— a raspy-voiced local sports announcer, named for a notorious bank robber—who became a police commissioner nursing higher political aspirations.

By the 1950s a counterbalance to the popular song, “Stars Fell on Alabama,” could have been “Bombs Fell on Birmingham.” A local KKK klavern (chapter) had organized a bomb-making group that began to blow up the homes, businesses, and meeting places of black residents. Martin Luther King Jr., inspired and led peaceful marches and was arrested, writing probably the movement’s enduring “Letter from a Birmingham Jail,” but there were two straws that finally broke the back of the anti-civil rights crowd.

Birmingham: Then and now

On May 2, 1963, a thousand young people gathered near Ingram Park for a peaceful “children’s crusade” engineered by King. Police promptly arrested them. The next day, with Bull Connor in charge, police overplayed their hand, bringing out attack dogs and fire hoses to stop other marchers. Almost immediately, all of America saw television images of the brutal encounter.

One week later, city leaders agreed on a desegregation plan. But the Klan bombers weren’t ready to give up, and, on September 15, 1964, two months after President Lyndon B. Johnson signed into law the Civil Rights Act, four young choir girls preparing for the Sunday service at the Sixteenth Street Baptist Church were killed in an explosion that also lives on in history. A few more bombs would hit homes and businesses after that, but the opposition soon petered out.

Through it all, most moderate whites avoided the “troubles.” A recent college graduate at the time, Beverly Anne Chace says she “pretty much read about it myself. Dad and Mother were very careful to keep us over the mountain” where the more affluent suburbs were located. She recalls that, although her father had been friendly with black acquaintances, he would never have invited them to his home. Now, in a different era, she reports, “There are black members of my Presbyterian church, unthinkable up to 10 years ago, and we mingle at concerts, restaurants, and everywhere else.”

In 1979, Richard Arrington became the first of four black mayors to date. In recent years, Black Enterprises magazine has called Birmingham the seventh most livable city for black residents, later identifying three local corporations among the nation’s top-grossing businesses with black owners. Statistics show a 70 percent black population in the city, and other strong ethnic groups include Greek, Italian, Jewish, and Lebanese.

Whatever the statistical breakdown, Kirk Thame, a black gastroenterologist from Jamaica, finds himself living in one of the city’s prestigious suburbs, Hoover. “My patients come from all walks of life,” he says, “and I don’t see racism in any walk of life.” Other sources agree, including the magazine Meetings & Conventions, which noted, “Diversity is the city’s greatest strength and strongest appeal.”

Eileen Lockwood is a world traveler and a regular contributor to UO’s Live and Practice department.