Sunday Interview: Access to safe playgrounds key part of reducing childhood obesity
Dr. Joseph Zanga came to Columbus in 2009 with a mandate to build a robust pediatrics program in the community.
As Chief of Pediatrics for Columbus Regional Health, he spearheaded the development of the Columbus Children’s Hospital at the Midtown Medical Center. He also recruited many pediatric specialists to the community and led a vigorous campaign to reduce childhood obesity.
Zanga is also a past president of the American Academy of Pediatrics, as well as author and co-author of numerous articles, abstracts, book chapters and reports.
Recently retired, Zanga sat down with reporter Alva James-Johnson and talked about his background, career and the recent loss of one of his two children.
Here are excerpts from the interview, with the content and order of the questions edited slightly for length and clarity.
Q: What was it was like growing up in the Bronx during your childhood?
A: It was very interesting. People have this impression that all physicians come from rich professional families, and I didn’t. We lived in a fourth floor, walk-up apartment in the Bronx, close enough to the Bronx Zoo that on a warm summer’s night, when we were outside, we could hear the elephants bellowing and the lions roaring, at least we thought we could.
My father was the equivalent of a hamburger flipper at McDonald’s, called a short-order cook at a diner. ... He died when I was in the sixth grade, my middle sister was in the third grade and my youngest sister was in kindergarten. My mother went to work as a switchboard operator at a charitable institution. ... She got a lot of education training there and became an assistant social worker. ... The first time I left New York for any length of time was to go to medical school in Chicago.
Q: When did you decide you wanted to become a doctor?
A: ... It was, I think in the end, a fairly gradual kind of thing. In the neighborhood we were on sort of a main street from the firehouse to where the fire engines went, and so that was interesting. That was exciting watching those fire engines come by the house, and the firemen hanging off the back. Policemen in those days walked their beats, and we got to know them, sometimes on a friendly basis, sometimes on a not so friendly basis. That seemed interesting. I liked my teachers in school, and so teaching was something that I thought I might like to do. Then I started working in, I guess, late grade school, eighth grade and high school as a junior counselor at day camps, and I liked working with children, liked teaching them to do arts and crafts and swim, and that sort of thing.
... I guess the other thing, too, was in high school we had a science teacher who saw some of us as interested in science, and so he gave us the laboratory at the end of the school day. ... And gee, science seemed like a very interesting kind of thing. So how am I going to put all these things together? I finally put them together as a physician. I could be a teacher. I could work with children. ... I could be a scientist. I could work and help people, kind of the example that my mother gave me when she was an assistant social worker, and that appealed to me.
... I started to come to the realization that if I managed to do well with children, if I helped their families to raise them healthy, they would live for 60 or 70 or 80 years. If I became an internal medicine doctor dealing with adults, I could try and help them to live a more healthful life, but I would give them 10 years, 15 years, not 60 or 70. The efficiency of being a pediatrician weighed on me.
Q: All right, so tell me how you got to Columbus?
A: I was in Greenville, N.C., a smallish town. ... There were changes going on at the medical school that were not what I came there for, and so I made mention of this to some of my colleagues. I had a fairly large group... of people that I had worked with (nationally) through the American Academy of Pediatrics. One of them was in Georgia, and she said, “Joe, I have the perfect job for you. I’ll send you the ad, but it’s a position that is just absolutely perfect for you, and it’s in Columbus.” I said, “Oh, Patty, I don’t want to go to Ohio. I just have no interest in Ohio.” “No, no, no, it’s Columbus, Ga.” “Where’s Columbus, Ga.?” She told me a little bit, and I looked it up on the Internet, and it looked interesting. My wife looked at it as well, and she said, “Yes, it does look interesting. Apply.”
... It really was something that I wanted to do because the administration of the hospital at that time said, “We’re looking for somebody who would be interested in building a pediatric department, a pediatric program, and a children’s hospital.” And they had in mind an almost free-standing children’s hospital, and, “You know, Joe, looking at your record and stuff, you’ve done a lot of building in your career. Would you be interested in taking on a task like that?” ... I said, “Of course I would. That’s what I do.” They said, “Fine. We’d like to offer you a job. Are you willing to accept?” Here I am.
Q: What was it like when you came here?
A: Great. I enjoyed the work I was doing, and again, it was a kind of thing that I had done. When I came... except for the neonatologist... I was the only full-time physician in the department of pediatrics, and so it was my responsibility to help figure out... the kinds of people we needed here, the jobs we needed them to do, and then go recruit. And so working with the recruiter, who was at Columbus Regional at the time, we brought in people in areas that we needed — pediatric hematology/oncology, pediatric neurology, pediatric critical care, primary care pediatrics, that was one of the last recruits that I did actually. In the end we were setting up a practice and I recruited the first three... African-American women in the department of pediatrics at Columbus Regional. They have an active practice now, and so I feel really good about that.
Q: What happened from there?
A: ... We started meeting about the development of a children’s hospital, and that was very exciting, too, meeting with the architects and designers, planners, working with Children’s Hospital of Atlanta for some advice and counsel on the kinds of things that we could do. Developing a telemedicine program here in Columbus because we knew that we were never going to be able to have some specialties here. There wasn’t the kind of population. For example, pediatric nephrology — kidneys — there wasn’t a need for a full-time person here to do that, and so we worked with somebody in Atlanta via telemedicine. ... The first day we set this up, we had three people who said, “Yes, we would much rather do this than drive two and a half hours to Atlanta, or two hours to Atlanta, for 15 minutes with the doctor, and then two hours back.”
Q: What else did you like about Columbus?
A: ... Bike riding was something I really like to do, and that RiverWalk was wonderful. It even interested me that down south on the RiverWalk there’s a sign that says, “Caution, alligators.” I never saw one, but it made me ride faster through that section of the RiverWalk. Wonderful. ... Then we’ve always liked the theater, but never were in a place where it was convenient. So we started walking to the symphony and the other concerts down at the RiverCenter, and it was terrific. Not only was the symphony terrific, you had to pay for that, but there were all these free concerts that occurred. Those were great too, and the plays at the Springer, and the plays that the CSU students did at their theater. Then the art gallery that they have downtown as well, and the art exhibits that they had. All those things were fascinating and easily available for us to do.
Q: You mentioned the children’s hospital and that whole project and renovations there at the Midtown Medical Center. Can you tell me about those improvements and what that has meant to Columbus?
A: It really did mean a lot because, for example, Dr. Paul LoDuca, the pediatric hematologist/oncologist, developed a very sizable practice of children. We have a significant number of children here with sickle cell disease, and no one was really providing care for them. They were going to Atlanta for care, and again, that was a long trip often for people who had not the best means of getting up and back from Atlanta, so it was difficult for them. Dr. LoDuca took care of these children, took care of them well. He was also a very good oncologist and took care of a lot of children with a variety of cancers.
... Dr. Samuel Edelman, I worked for two years to recruit him to come here, and he did. Critical care doctor, excellent. An actually brilliant person, and he helped design a five-bed critical care unit at the hospital, which the Woodruff Foundation helped to fund. ... Before that, when we had terribly, terribly sick children that we didn’t have the expertise to take care of and I could only take them so far, we’d have to send them up to Atlanta sometimes by helicopter. Now those children could be cared for here. It was uncommon for us to send anybody to Atlanta for critical care.
We developed a pediatric emergency department so that the children would be seen in an area that was designed, equipped and staffed for them, not in the middle of the mayhem of the trauma center of the emergency and trauma center — really an adult oriented facility, which is excellent, but not designed for children. So we set up a pediatric emergency department, brought in a pediatric neurologist because there was none in this area.
Q: So we don’t have a free-standing children’s hospital here in Columbus, right?
A: No, we have a hospital within a hospital. ... That’s not a bad thing, but what happened after I left was we lost the hematologist/oncologist, he left. He went to Mobile, Ala. We lost the pediatric critical care doctor. He went to work with some of my friends in Richmond, Va. And the cardiologist that we had, he retired, and so we’re working with Sibley Heart Center up in Atlanta, and they’ve been sending a cardiologist here one or two days a week, so it’s rotating. They’ve done good work, but not a person who’s living here. Now they’ve hired somebody, so there’s now a full-time cardiologist again here. I mentioned orthopedics is bringing the second orthopedist. Good, they’ve got that. So it’s a process now of developing, redeveloping, and that’s a slow and painful process. I know because I lived through it.
Q: Did a lot of those people leave because you left?
A: They didn’t leave because I left, but they saw opportunities elsewhere that they didn’t or might not have here.
Q: Why did you decide to retire when you did?
A: Because I was approaching 70 years old. I’ve been working for more than 40 years doing what I’ve been doing. There are a lot of things that in this community I wanted to do and didn’t have the time to do — volunteer kind of activities, being on different boards and committees, and working with children in a different way. ... I wanted to spend more time with my grandchildren, and I wanted to be able to do these things without having to go to somebody and say, “Can I take a few days off? Do I have to use vacation time to do this?”
... I just came back from a meeting with the District Wellness Committee for the Muscogee County School Board ... And I’m an elected member of the parish council at my church. ... I am a court-appointed special advocate, so I’m working with Children’s Tree House to help children who are abused, neglected or in foster care. I did that a lot when I was particularly at the Medical College of Virginia. I was chair of their child abuse and neglect committee there.
Q: Haven’t you done some expert testimony in some court cases as well?
A: I have. ... The defense attorney at one of these cases called me a voodoo doctor because I bewitched the jury. ... It was a child abuse case, and yes I have that kind of expertise.
Q: I have done some research and discovered that you were president of the American Academy of Pediatrics.
Q: You also are part of a group called the American College of Pediatricians that broke away from the American Academy of Pediatrics due to differences on some issues, and there’s been some controversy about that.
A: Less broken away than taking a different approach. ... We are a much more science-based organization than a membership organization. What we try and do is look at a variety of issues that affect children and potentially affect children for good or bad, but we’re worried more about what might affect children adversely, and really heavily research the issue.
The issue that brought the American College of Pediatricians in to existence was really based on a statement by the American Academy of Pediatrics that ... a pediatrician in academic practice in Seattle researched very carefully, and found that the citations were not quoted appropriately, and so the conclusions drawn from the citations were also not appropriate.
Q:... My understanding is that the debate had to do with gay marriage, adoptions of children by gay couples, abortion, and that the American College of Pediatricians, they tend to have a more conservative view of those issues. Some gay rights groups have criticized the organization.
A: Yes. The Southern Poverty Law Center lists the American College of Pediatricians as a hate group along with several hundred other groups in the country.
Q: So what’s your response to that, because you’re still affiliated with that group, aren’t you?
A: I’m an adviser to their board. ... We do not object, not as an organization, to gay marriage. We don’t object to it at all, but the American Academy of Pediatrics has published a fairly recent statement about the importance of fathers, male fathers, in the lives of children and how critical it is for their rearing. Yes, there’s science there, we agree. On the other hand, they say that it’s appropriate for a gay family, parents, to raise children. Well, we question that, and what we say as pediatricians, we take care of these children. We welcome their families in to our practices, but we talk to them about the importance of male figures where there is no male figure in the house, female figures where there is not a female figure in the house. In fact, the academy had a task force years ago, the task force on the family. And in that task force report it says that the optimum rearing of children is done by a male father and a female mother, so the academy in many ways contradicts itself on a lot of these things.
There’s a lot of science that says that children don’t have the ability to make executive decisions — life-changing decisions — until they’re in their early to mid-twenties. Now, science has proved that (through) functional MRI’s, and a variety of other ways, and the academy says that. Now, interestingly, both Socrates and Shakespeare said the same thing just from observation, but there’s scientific proof for that now. But the academy takes the position that adolescents, without any parental guidance, can make decisions about birth control, abortion. ... They don’t have the... intellectual capacity to understand the ramifications of that, and so we teach differently. Now, do we shun children who decide that they’re going to have an abortion? No, we take them in to our practices.
Q: You’re affiliated with both groups, though, right?
A: Most of the members of the American College of Pediatricians are members of the American Academy of Pediatrics. ... And, yes, I’m still a past president and I still attend their Past President Advisory Council meetings, and I go to their education meetings once every other year. ... I am still an active member of the American Academy of Pediatrics.
Q: What’s the childhood obesity rate in Columbus? Do you have any idea?
A: ... The specific rate I can’t quote that to you anymore, but it is probably... more than 30 percent of the children in Columbus (that) are overweight or obese.
Q: And you were part of a state campaign to address the problem.
A: Live Healthy Columbus was what we became, but it was something that Children’s Healthcare of Atlanta started, and they wanted to do a major project to deal with the problem of statewide obesity. They needed a place to pilot the program. I was working with them on some other things related to this. ... They asked me, “Would you be willing to do the pilot project here in Columbus?” I got a group of people together and they said yes.
Q: Has it made a difference?
A: It was starting to show some change, but more what it did was it raised awareness and people are now more willing to consider and talk about the issue than they were before. There’s an endocrinologist in the community who is working with a research center at Auburn on some of these minor hormone kinds of things, which may influence some children, because... we know it’s not just diet and exercise. Some children have something else going on, and he’s looking at some of those other things that might be impacting these children.
Q: All right. On a personal note, and I hope you don’t mind me bringing this up, but I recently learned that you and your wife lost your daughter (in 2014). If you don’t mind sharing with us, what has that experience been like for you as a father?
A: ... She decided to be a lawyer, and she went to one of the best law schools in the country, University of Virginia, graduated well. ... She had her first child while (working in Gaston County, just outside of Charlotte, N.C., prosecuting domestic violence cases), a second child then three-and-a-half years later. She had some medical issues after the first pregnancy, and then the second pregnancy some more medical issues. ... Because not only was I her father, I’m a physician, I said, “Catherine, these things that you’re dealing with, you really need to get them taken care of.” ... She was here for Thanksgiving and she didn’t look right. ... She went home. After Christmas she called and said, “I’m starting having trouble breathing sometimes going upstairs.” ... Well, she finally went one day to an urgent care center where she saw a mid-level professional who said, “Oh, I think you have asthma,” and put her on some asthma medicine. ... I knew she didn’t have asthma. There’s no history of asthma with her or the family. (I said), “Catherine, you know you need to see a doctor.” And so finally, when she was having trouble, she just couldn’t deal with it anymore, she went to see a doctor. The doctor immediately sent her to the hospital for an x-ray, and she had a chest full of fluid. They tapped the fluid, and I was hoping, hoping it was heart problems, and they said, no, this is a tumor. We’ve got to find where the tumor is. It was ovarian cancer, which is difficult to diagnose, and for her it was stage 4, and it was very hard to deal with because stage 1, even stage 2, is treatable, maybe curable. Stage 4 is probably not.
... Part of me, I’ve lost my oldest daughter, the only person in the family who would argue with me intellectually, and we had some very interesting discussions. There’s another piece of me, and it says, “You’re a doctor. You should have been able to help her, and I couldn’t.” At both levels that hurts.
Q: Thank you for sharing that story.
A: It’s an important part of my life.
Dr. Joseph Zanga
Hometown: Bronx, N.Y.
Current home: Columbus
Job: Retired Chief of Pediatrics of Columbus Regional Health/Columbus Children’s Hospital
Previous jobs: Catherine and Max Ray Joyner Distinguished Chair and Assistant Dean in Primary Care at Brody School of Medicine, East Carolina University; Chair of Pediatrics, Loyola University in Chicago; Vice chair of Pediatrics at Louisiana State University Medical Center; Professor of Pediatrics and Emergency Medicine at LSU; chair of the Division of Primary Care and Emergency Medicine at Medical College of Virginia, Richmond.
Education: Bachelor’s degree in biology, Fordham University, Bronx, N.Y., 1966; M.D., Stritch School of Medicine, Loyola University, Chicago, 1971.
Family: Wife, Christine, of 47 years; two children, one deceased; five grandchildren.