It is said that Iowans will defend to their death the right to be wrong about anything.
If they’re wrong, they’re going to be wrong in a big way.
Organ transplantation expansion in Iowa
That is evident in an ambitious program Des Moines’ two largest healthcare players have recently undertaken to dramatically expand organ transplantation in central Iowa. Mercy Hospital Medical Center and Iowa Methodist Medical Center, normally business rivals, are joining forces to compete with the University of Iowa in Iowa City by offering coordinated and expanded transplant services in Des Moines.
“We have two of the three major healthcare deliverers in central Iowa unified in their approach to the delivery of healthcare,” says Maureen Martin, MD, who heads the new venture. “We are coming together even though, if you look at it from a business perspective, we are competitors.”
The program, which is pending approval by the Iowa Health Facilities Council, is to be known as the Central Iowa Transplant Association. If the certificate of need is approved, Mercy Hospital would begin performing pancreas transplants and Iowa Methodist would perform liver transplants by the end of the year. The association is also planning to offer pediatric transplant services at Blank Children’s Hospital.
At the Mercy Hospital Medical Center, a 673-bed acute-care Catholic hospital, kidney and heart transplants are currently being performed. The Mercy system includes the medical center, 12 hospitals in smaller Iowa communities, and 23 clinics. It is affiliated with the Midwest Rural Telemedicine Consortium which connects 32 hospitals through fiberoptic technology. The system is used for physician education as well as clinical purposes.
Kidney transplants are already performed at Iowa Methodist Medical Center. The Iowa Health System also includes Iowa Lutheran Hospital, and Blank Children’s Hospital, as well as Integra Health, an organization of primary care physicians in 35 communities in eastern and central Iowa. It also include hospitals in Cedar Rapids, Waterloo, Sioux City, Dubuque, and Ottumwa.
Martin, the director of transplantation at Iowa Methodist Medical Center, came from Iowa City earlier this year where she headed the multi-organ transplant program at the University of Iowa. “Because of a change in leadership at the university from the top all the way down, it was difficult for me to grow the program the way I wanted to grow it,” she says. “I had a wonderful opportunity in Des Moines with the Iowa Health System to do that. So what we’re planning is to develop multi-organ transplant services in central Iowa in a large quaternary referral center.”
Martin says that it is becoming necessary for major medical centers to offer transplant services, even though the university setting has been the traditional site of such services. “We think about transplantation as being part and parcel of what any major medical center has to offer whether it be university or private hospital,” she says. “There has been an explosion of organ transplant centers across the country and we’ve gone from just a handful of centers in the early 80s to over 300 centers across the country now.” She adds that the private and community medical centers are not only providing transplant services equal in quality to the university centers, they are doing it cheaper.
“The universities are not the ivory towers of health-care delivery that they used to be,” Martin says. “The delivery of excellent care is possible in major health-care centers that are willing to develop a center of excellence.” That is exactly what this consortium is to be for central Iowa.
Growing such a center may be challenging. According to the United Network for Organ Sharing, organ donations are not keeping pace with the demand for transplants.
Friendly competition in Des Moines
The cooperative spirit seen in the joint venture perhaps underlies all the competetive undertakings of the various health systems and hospitals in the community. Physicians in Des Moines often admit patients to several of the hospitals and are friendly with each other.
“The doctors on an individual basis that meet on the golf course and in the hospital making rounds are usually very cordial an friendly to each other and they see each other socially,” says Greg Ingle, DO, the chief of staff at Des Moines General Hospital. “It’s just when the large groups get involved as a whole that we get into problems.”
Ingle says that although Des Moines General does compete with the larger hospitals, it has its own niche. Many of the most active physicians on staff there are osteopaths, and the hospital emphasizes personal attention to the patients. “It’s a smaller hospital in town so everyone knows everyone else. It kind of keeps you away from the patient-by-number routine that you can get into with the bigger organizations.”
Ingle says this works well for both the staff and the patients, although, as a smaller hospital it does have limitations. “There are some hospital things that we cannot do because of our size, for example, we don’t do neurosurgery and things like that,” he says. Des Moines General offers emergency services, maternity care, geriatric mental health care, and a day-care program for sick children.
Broadlawns Medical Center has residency programs, as does Des Moines General, and both focus on primary and general hospital care. Broadlawns provides mental health services, family, and primary-care centers.
Blank Children’s Hospital is the only Iowa hospital devoted exclusively to pediatric care and has Iowa’s only pediatric emergency department. David Alexander, MD, the medical director at Blank, says that although Des Moines has had a children’s hospital for more than 50 years, a rapid growth and expansion of services has come in the last several years. “This is a children’s hospital that up until five or six years ago not a whole lot of people had heard of. People are starting to get to know us and what we do. Last November with septuplets here, everybody in the world got to know us.”
When the world’s first surviving septuplets were born in Des Moines last fall, media from around the nation monitored the babies’ arrival and status as they were taken home one or two at a time.
Population growth, as well as increasing services, have generated needs for both primary-care and specialty physicians in the city, according to Alexander. He says the most challenging part of recruiting physicians to the area is getting them to come see Des Moines. “We’ve had a very high success rate of getting people here once we get them to get on a plane and come here. The big struggle is getting people to actually come look at a job in Iowa.”
Martin hopes to recruit physicians for the transplant program right away and anticipates the need for additional physicians. “I am going to recruit whatever team it takes to develop these centers. We will recruit two new surgeons that will allow for expansion of the program.” And, she adds, “we will need physician support, not just surgeon support, for the program.”
Ingle, a native of Prairie City, 20 miles east of Des Moines, says that many physicians who train here tend to stay, providing a stock of physicians for the area, although some specialists must be recruited from outside Des Moines. “It depends on what specialty you’re talking about. There are at least three or four training programs right here in the Des Moines area. Mercy has a family practice residency program, Methodist has several residency programs, Des Moines General has several residency programs and Iowa Lutheran has residency programs. So it’s kind of like we have a large labor pool right here under our nose, but certainly [positions in] some specialties are available.”
The University of Osteopathic Medicine and Health Sciences, the second largest college of osteopathic medicine in the nation, trains physicians in Des Moines, many of whom stay to finish training and practice.
Physician work culture in Des Moines
Physicians are not the only products that are home-grown in Des Moines. Agriculture is a mainstay for the state of Iowa, if not the city of Des Moines itself. Iowa leads the nation in the production of corn, soybeans, and pork, also ranking high in beef, turkey, eggs, dairy, and honey production.
The Des Moines economy is more diverse, however. “Although we’re in a farm state and a very rural state, there’s not much farm economy in Des Moines. Des Moines runs off of financial services and publishing,” says Alexander.
In fact, Des Moines is a leader in the insurance industry—the third largest insurance center in the world, ranking only behind London and Hartford, Connecticut, with home offices of more than 60 insurance companies. Publishing and health care also contribute substantially to the economy, along with state government.
Des Moines has cultivated a valuable workforce to support these industries through its education system, which focuses on producing socially prepared and work-ready citizens. An unemployment rate of about two-and-a-half percent testifies that the citizens of Iowa are able and willing to work.
Alexander says he has found the workforce to be educated and motivated. “There really is this midwestern work ethic which is alive and well. People enjoy working and enjoy coming in and getting a good day’s work done, which is great in my position as an administrator. We have a terrifically well-educated workforce who like to come to work.”
As an added benefit to the hospital, the work ethic extends to volunteer work. “It’s a pretty active community in terms of community involvement also. People are interested in volunteering,” says Alexander.
Because companies in Des Moines are able to balance support for the family with a strong work ethic, a high percentage of mothers in Des Moines are working. That statistic led Redbook magazine to name Des Moines one of the ten best cities for working mothers in 1996 based on the quality education, low crime rates, cost of living, child care choices, and corporate support of working mothers.
Martin, who is originally from Montreal, is pleased with the setting for her new venture. “I think it’s a wonderful midwest city. It’s truly a city compared to Iowa City which is a little college town. It’s basic good, honest, midwestern living. Nice people, low crime, the weather’s not great in the winter time but in the late spring it’s beautiful. The educational systems are great, unemployment is very low, people believe in God—it’s a real nice place to live.”
Ingle agrees with Martin’s assessment. “We’re all busy yet there’s that midwestern usually helpful, friendly attitude.” he says.
Other people must agree, too, because builders in Des Moines have been busy. The city has in many areas rebuilt itself in the last 25 years. The construction of insurance and other office towers, a civic center, shopping mall, and condominiums along with other major construction projects completed between 1974 and 1997 has dramatically changed of face of the downtown area. To protect downtowners from climate extremes, many of the downtown office buildings, hotels, parking garages, stores, restaurants, and movie theaters are connected by a system of skywalks more than two-and a- half miles long.
The Des Moines River, for which the city was named, bisects the city into eastern and western sections. The western section is the dominant business district, while the state capitol, fairgrounds, and botanical center are on the eastern side. The Raccoon River further divides it, separating the main downtown area from the southern neighborhoods containing the airport, zoo, and several large parks.
Aside from downtown redevelopment, growth in the city is predominantly westward, into the suburbs of West Des Moines and Urbandale. In West Des Moines, which features commercial development as well as residential, the population grew by 40 percent between 1980 and 1990.
Despite its Midwestern location, Des Moines is a fairly diverse community. Hispanic, Bosnian, Southeast Asian, and Sudanese immigrants add spice and diversity to the population.
According to Alexander, the community is prepared for changes that immigrant populations bring. “It’s a very tolerant community. Sort of typical of what your stereotype of the upper midwest is. People tolerate diversity and they’ll tolerate just about anything. You name it.”
Excellent education in Iowa
One thing Iowans may not tolerate, however, is a substandard educational system. The work ethic is instilled in young Iowans from an early age. Excellence is expected in school work and that expectation pays off.
Ingle, who served as president of the school board in Prairie City, says “I think the school system is one of the strengths. Part of that has to do with small classes and the expectations of parents and teachers. They expect the kids to behave and do their work.”
“I think it’s a community that really values education,” says Alexander.
“The level of education among the average folk in Des Moines is high.”
For years, Iowa’s schools have been among the best in the nation. The state ranks at or above the 90th percentile compared with other states in the Iowa Test of Basic Skills, Iowa Tests of Educational Development, and ACT scores.
Des Moines schools are among those but the system has seen slight drops in overall achievement test scores in recent years. School representatives attribute this drop to an increase in the number of immigrant and poor students who present special challenges for the system. At the same time, more students are scoring above average than before, indicating a wider discrepancy between the lower achievers and the higher achievers.
The governor has called for improved pay for teachers, improved preschool and kindergarten opportunities, and support of local control to keep all the state’s school systems on the right track. Des Moines schools recently received a $2.4 million grant to boost its English language instruction for non-English proficient students.
Alexander, who lives in West Des Moines, is impressed with the schools “The public schools are terrific. There are parochial schools here but there are virtually no private schools. The public schools are that good.”
The quality of education contributes to a high quality of life for families in Des Moines, according to Alexander, but other elements come into play as well.
Resources in Iowa
“Sometimes people have the perception that we are stuck out here in the middle of a cornfield—and in some ways we are,” says Ingle with a laugh. “But it’s a big spot out in the middle of a cornfield, so there are things to do.”
Indeed, whether it’s a local theater production, a touring show, or a sports event, there is always something to do in Des Moines.
“We have been pleasantly surprised with the resources that are here,” says Alexander, who moved to Des Moines from Philadelphia. “Jerry Seinfeld is playing in New York City and doing six weeks on Broadway. He’s doing two stops before he goes to New York and this is one of them. Kind of amazing.”
Alexander adds that in Des Moines, people take advantage of the cultural resource at their disposal. “I think people tend to take more advantage of the cultural opportunities that are here than I was used to coming from Philadelphia and New York City. Because there may not be the 50,000 different things that you can do every night, people take more opportunity. There is a professional orchestra and they sell out their concerts. When touring companies and shows come to town they are usually sold out. I think the community does take advantage of resources that are here in ways that I hadn’t seen elsewhere.”
Well-attended local productions include theater groups, the Des Moines Metro Opera, Opera Iowa, Des Moines Community Orchestra and the Des Moines Symphony. Touring productions of popular current shows such as “Rent,” “The King and I,” and “Chicago” are scheduled to play in Des Moines in the coming season.
Other art forms are well patronized as well. The Des Moines Art Center displays an impressive collection of 19th and 20th Century art, which is worthy of its home: a building with wings designed by the renowned architects Eliel Saarinen, Richard Meier, and I. M. Pei. Regular events generate interest in frequent visits to the center. One of the largest geodesic domes in the nation provides an impressive facility for seasonal displays of plants, flowers, and free-flying birds at the Des Moines Botanical Center.
The Iowa Cubs AAA baseball team has been a mainstay of Des Moines sports for 30 years. An arena football team, hockey, soccer, and basketball are all part of the spectator scene as well.
Golf courses in summer and skiing in winter keep people moving, and residents enjoy hunting and fishing—including ice fishing in winter. Although weather extremes do occur both winter and summer, there are plenty of pleasant days for outdoor activity.
The agrarian surroundings of Iowa make their appearance in Des Moines in the form of a bountiful farmers’ market held summer Saturdays along downtown’s Court Avenue. The Living History Farm in Urbandale, a 600- acre open-air museum, demonstrates the history of agriculture in the Midwest.
Iowans look skyward for adventure, too. The National Balloon Classic, which hosts the North Central Regional Championship competition, is an annual week-long ballooning festival held in Indianola, where the National Ballooning museum is located.
These attractions may not draw many people to Des Moines to vacation, but residents, both native and transplanted, say it’s a comfortable place to live and raise a family. Alexander relates something he was told about Des Moines: “When I was being recruited here, somebody said, ‘It’s a great place to live but you wouldn’t want to visit here.’ It’s absolutely true.”
Bett Coffman is the associate editor of UO.