Science & research

Passionate pediatrician

Dr. Terry Klassen is leading an effort to turn Winnipeg into a major centre of research for children's health

Katelin Moffatt (L) and Megan Reid get down to the business of colouring with Dr. Terry Klassen.

About the Manitoba Institute of Child Health Networking for better health care Bio: Dr. Terry Klassen

BY DOLORES HAGGARTY
Winnipeg Health Region
Wave, May / June 2011

The parents were in panic mode.

One day, their four-week-old baby boy was the picture of good health. The next, he was struggling to breathe, his little chest heaving violently with each gasp for air.

Now, they were in the emergency department at Children's Hospital, hopeful that the doctor on call that day would be able to do something - anything - to help their child.

By this time, the parents knew that their baby was suffering from bronchiolitis - an acute viral infection of the lower respiratory tract that can afflict babies in the first year of life.

What they didn't know was that the man diagnosing and treating their infant son on that day last February was Dr. Terry Klassen, one of Canada's top pediatric researchers and the man who helped write the book on how to treat this particular kind of infection.

Klassen first became interested in bronchiolitis while working as a pediatric physician in Ottawa during the late 1980s and early 1990s. At the time, he realized there were no definitive guidelines for treating children with the condition.

"In some cases, doctors would treat with ventolin or an oral dose of theophylline, which could be toxic at times," he says, recalling the challenges faced by pediatricians. "In many cases, the infant would have to be admitted to hospital for further tests and treatment."

Then Klassen remembered that one of his former professors in Manitoba, Dr. Victor Chernick, a pediatric pulmonologist with an international reputation, had talked and written about using epinephrine to treat bronchiolitis in certain situations.

Klassen decided to test his teacher's idea. Already conducting research into pediatric head injuries and croup, Klassen added bronchiolitis to his list of investigations. It took years of painstaking work: getting money for research, designing the studies, collaborating with other health-care professionals across Canada, and comparing information on thousands of children. "It's not like 'bang,' and there's an answer." But an answer finally did emerge: infants and small children with acute bronchiolitis react best to short-term treatment with adrenaline/epinephrine.

This, then, was the knowledge Klassen was able to carry comfortably to the concerned family that day at the Children's Hospital. "At first, with all his huffing and puffing and gasping for breath, you worry his little lungs might tire out and you might have to put a tube in to help him breathe," says Klassen. "And yet, we were able to give a couple of epinephrine masks and he turned a corner. So rather than end up in intensive care, we were able to send him to a pediatric ward."

Moments like these give meaning to Klassen's work and generally underscore the importance of research, especially when it comes to enhancing care for children. "It was a neat experience," he says. "You take this evidence, you apply it, it makes a difference in the child's life and the parents may relax a bit. It keeps you relevant, keeps you focused."

Klassen's passion for his work is obvious. A quick look at his resume reveals a list of achievements that would be enough for several careers. In addition to groundbreaking research and more than 150 published articles, Klassen has also played a key role in starting up research departments almost from scratch in Ottawa and Edmonton, and has established or helped create a number of national and international research networks. In doing so, he has helped redefine the nature of pediatric research and care in Canada.

No surprise then that when the Children's Hospital Foundation, working with the University of Manitoba's Faculty of Medicine, started looking last year for a top-flight pediatrician and researcher to lead the Manitoba Institute of Child Health, they decided Terry Klassen was their man.

Dr. Brian Postl, Dean of the University of Manitoba's Faculty of Medicine, says Klassen was an obvious choice. "He is one of the premier pediatric researchers in the country," says Postl, who is a pediatrician and former President & CEO of the Winnipeg Health Region. "He sees health care and educating young professionals from a broad population health perspective. And, of course, he has had experience in several health systems across the country, and brings that experience with a very mature, thoughtful and visionary approach to the roles he fulfills.

For Klassen, the offer was simply too good to pass up.

Located at the Faculty's Bannatyne campus, the Manitoba Institute of Child Health is one of the province's bestkept secrets. It was created in 2001 and incorporated in 2007 by the Children's Hospital Foundation Inc., working in partnership with the University of Manitoba's Faculty of Medicine, Winnipeg Health Region and Health Sciences Centre Children's Hospital. With over 80 people on site and more than 200 affiliated principal investigators working on a range of projects at facilities across Manitoba, MICH is the largest research organization of its kind on the Prairies, and enjoys a solid reputation in the pediatric community.

As such, it also serves as a kind of template for Manitoba's emerging Academic Health Sciences Network, which is being developed by the Region and the University of Manitoba's Faculty of Medicine. The idea is to use the network to promote greater collaboration in clinical, education and research programs which will, in turn, enhance clinical care for patients, training for students and support for researchers. The network will also make it easier to recruit top-flight researchers to Manitoba.

Klassen's mission is to build on MICH's record of achievement by taking it to the next level and establishing it as one of the finest institutes of its kind anywhere in the world.

It's a tall order, but one that Klassen embraces with all the enthusiasm that he has displayed throughout his nearly 30-year career. The fact that he gets to do it all in his home province is a bonus.

Born in 1957, Klassen is the son of Mennonite missionaries and spent his early years in Flin Flon and Central America. By the time he entered his teens, the family had returned to Manitoba where Klassen went on to medical school at the University of Manitoba.

He describes himself at that time as "a shy guy - understated but thoughtful - with deep friendships." Shortly after graduation from the University of Manitoba in 1982, Klassen and his family moved to Brandon where he settled into a general pediatric practice.

A short while later, Klassen responded to an advertisement in the Canadian Medical Association Journal for a full-time pediatric emergency doctor at the Children's Hospital of Eastern Ontario (CHEO). It would be a major turning point in his life.

After what could be described as a seminal meeting with Marilyn Li - then Director of Pediatric Emergency at CHEO - the young family moved to Ottawa. Under Li's mentorship, Klassen thrived. "She saw something in me that others hadn't yet identified. She told me I was going to be chief of a department one day," he recalls.

At that time in Canada, there weren't any specialized pediatric emergency department doctors, nor were there any training programs in that area.

Under Li's guidance, Klassen and others led the way to developing the definitive skill sets required to be a pediatric emergency doctor. Eventually, the Royal College of Physicians and Surgeons of Canada developed pediatric emergency medicine into a two-year sub-specialty program.

Research was another requirement on the job in Ottawa. This was a new field for Klassen, and, being curious, enthusiastic, and passionate, he threw himself into the work.

It was heady stuff, working in pediatric emergency and doing research. And since that time, all of his research has emerged from the pediatric emergency department. "Peds emergency is a rich environment," he says. "The choices are never clear. Many of my research questions have emerged from hitting a perplexing question as you care for children," he says. "For instance, what is the best way to do this and if there isn't any answer, you have to research to find the answer for children."

His work in Ottawa attracted the attention of recruiters at Stollery Children's Hospital in Alberta. In 1999, he moved to Edmonton and became Chair of the Department of Pediatrics at the University of Alberta and the founding Director of the Alberta Research Centre for Health Evidence.

It was there that Klassen proved to be a formidable builder. Under his leadership, Stollery developed a fully staffed 24-hour pediatric emergency department. He also carefully crafted the hospital into Western Canada's main referral centre for pediatric cardiac surgery. On the research side, he increased research dollars from $4 million to $20 million a year.

In 2010, though, after a year-long sabbatical, he was at a crossroads in his career. His initial plan was to continue working primarily as a clinical scientist. He had been awarded a major grant of $200,000 a year for seven years to work in knowledge translation. (Simply put, knowledge translation is working to exchange research ideas, combine research knowledge, apply that knowledge ethically and make it better known to the larger community.)

That's when Manitoba beckoned.

"Manitoba came knocking and I really listened. Just how often in life do you get to come back home and be presented a great opportunity at the right time in your professional life? I came back to Winnipeg because I was excited about the job."

Klassen arrived in Winnipeg in September 2010. Now, eight months later, he is in building mode again. "I was brought in to provide leadership, to give vision, to give direction and to put the right team in place to advance the research here." He continues: "I need to make MICH a wonderful, great research institute that's advancing knowledge so that we can dramatically improve the care of the children and youth we serve."

And what does that entail? Klassen says a well-run institute must be able to attract top researchers and manage money. But it must also be able to demonstrate its success. One key measurement of success will be how effective MICH is in enhancing the delivery of care for children. Another measurement will be how much of the work done by researchers at MICH is published in respected medical research journals. Philanthropy is also an important marker. If the work has merit, it will gain attention and attract donations to fund research at the University of Manitoba and MICH.

And Klassen is clear as to how he will reach his goals: "Through recruiting more researchers and making those we have more effective. We also need more grant money to further their effectiveness and to advance knowledge."

Klassen says the building blocks for creating a great research institution are already in place, and he suggests a tour of the facility to hammer home the point.

Located on the fifth and sixth floors of the John Buhler Research Centre, MICH occupies 60,000 square feet, enveloped in soft grays, blues and greens, with touches of muted orange and yellow. It's a state-of-the-art research environment designed for aesthetics, function, safety and comfort.

Klassen says MICH is already involved in some high-profile research projects. As an example, he singles out the Biology of Breathing theme (BoB). Launched in 2003, BoB became the first theme-based research group at MICH. It's described as a multi-disciplinary program focused specifically on pediatric respiratory challenges such as asthma, the most common chronic condition affecting children in Canada today and the top reason for children being admitted to hospital.

The theme leader is Dr. Andrew Halayko, an Associate Professor of Internal Medicine and Physiology at the University of Manitoba. Under his leadership, more than 15 principal investigators at the Faculty of Medicine are working with other collaborating investigators from diverse disciplines such as physiology, pharmacology and internal medicine to unlock some of the mysteries of childhood lung diseases.

One interesting line of research centres on the use of nanotechnology, which involves testing drugs in artificial airways made of synthetic material in which human lung cells can grow. This research was recently awarded a $1 million grant to be shared with British Columbia. The size of the grant underscores the importance of the work, says Klassen. "People don't just dole out a million bucks unless there's something important going on. This is not just some little research outfit. This is the big leagues."

Given the number of researchers at MICH, it is impossible to highlight each individual doing important work there. Nevertheless, Klassen is comfortable referring to Dr. Allan Becker as one of the "star" researchers at the institute.

As a professor and Head of Allergy and Clinical Immunology in the Department of Pediatrics and Child Health at the University of Manitoba's Faculty of Medicine, Becker has spent nearly two decades devoted to the study of childhood asthma, investigating the early-life origins of asthma in children. His early study of asthma genes and the environment included sending questionnaires to the homes of 16,320 children born in Manitoba requesting detailed information about family health and the home environment.

His initial work showed that childhood asthma could be reduced by nearly 60 per cent if babies were breastfed and had limited exposure to allergy triggers such as dust mites, animal dander and tobacco smoke. Becker is currently Site Leader and Co-Principal Investigator in the Canadian Healthy Infant Longitudinal Development Study. The objective of the study is to track a group of 5,000 children in Vancouver, Edmonton, Winnipeg and Toronto from birth through age five to examine the impact of environmental factors on children's health.

"Studies like this are absolutely critical if we're going to understand the origins of diseases like asthma," says Becker. "When we began our prevention study in the early 1990s we thought we knew everything that we needed to help prevent this disease. Now we need to understand a whole lot more."

The recruitment of moms and their children is an important factor in a research project like Becker's. According to Klassen, Winnipeg scores high in this area. "It seems like the Winnipeg site has some intrinsic advantages over some larger sites because of the closer relationship between the team here and obstetricians. They can make it happen so the recruitment rates can be higher and that is often the critical thing for the success of the project," says Klassen.

Dr. Richard Keijzer, Assistant Professor of Pediatric General Surgery at University of Manitoba's Faculty of Medicine, is another researcher creating a stir at MICH. Klassen describes him as an "absolutely brilliant pediatric surgeon" who last year chose to come to MICH from Rotterdam when he had the opportunity to work just about anywhere else in North America.

As a principal investigator with the BoB group, Keijzer specializes in congenital anomalies, with a special interest in the repairs of congenital diaphragmatic hernias. (These occur when the fetus's diaphragm doesn't fully develop and the abdominal organs push up into the tiny chest, impeding proper lung formation.) This life-threatening condition is often picked up through a fetal assessment, ensuring that preparations can be put in place so that immediately after delivery the newborn can be rushed to a neo-natal intensive care unit where he or she is quickly intubated (tubes inserted into the air way) and placed on a ventilator. Once the infant is fully stabilized, the hernia is repaired surgically.

"I think Keijzer is going to make an impact on that field," says Klassen. "He's doing stellar work in trying to understand why some children are born with a diaphragmatic hernia, and at the same time, he's a surgeon who came with an exceptional clinical skill: he's doing what we call minimally invasive surgery."

Another important avenue of research centres on the work of Dr. Jon McGavock, who has completed postdoctoral studies in Kinesiology and Recreation Management and works within the Diabetes, Metabolism and Obesity group, which is fast developing into MICH's second major theme of study.

McGavock, an Assistant Professor in Pediatrics & Child Health at the University of Manitoba's Faculty of Medicine, was recruited from Texas three years ago and is described by Klassen as one of the new breed of researchers. Like others at MICH, McGavock had his pick of placements: "I interviewed at Texas, at McGill, at University of Toronto and at University of Alberta, but MICH's investment in me was 10 times higher than anywhere else."

McGavock's research is focused on Garden Hill, a northern First Nations fly-in community of almost 4,000 Oji- Cree people where Type 2 diabetes is 12 times higher than the national average.

Although some of his work takes place in his office and lab, he spends a great deal of time working within the community. Over the past couple of years, he has helped create a fitness centre and is working on projects in the school with an emphasis on peer mentoring. The goal is for children to develop relationships and self-esteem and become more active. Diet also plays a huge part, and to that end, McGavock twice last year took 4,000 pounds of fresh produce to the community. The produce sold out in four hours.

He admits his goals are lofty: "We're figuring out how to manage children with Type 2 diabetes, we're figuring out who is at risk of Type 2 diabetes, then we're preventing Type 2 diabetes in high-risk children. And, in the next few years, we want Garden Hill to be known for its innovative approaches to healthy living rather than its lack of water and diabetes rates."

Like Klassen, McGavock's passion is contagious - not only for his concern about the health of children, but also for his zeal in demonstrating the lesserknown benefits of research. "Here," he says, pointing to a poster that reads: Economic Benefit of Investing in Dr. Jon McGavock's Lab. "This is where research goes beyond health benefits."

Investment over three years from MICH (through the Children's Hospital Foundation) = $437,000; investment from federal grants over same period = $2,550,000; other monies invested in program = $705,000. In other words, for every dollar McGavock has received from MICH, he has matched it seven times over from other funding agencies.

And the benefits don't stop there. McGavock directs attention to a photograph of summer students who worked in Garden Hill. "So these are undergrad students who come in for summer jobs, and these three now are med students, this one came to work for us and is now doing his master's in public health because we encouraged him to go back to school, and this is a PhD student we recruited back from Montreal and . . . ." He continues: "Inviting me to be here, I'm just a drop, but if I can create 20 of these (students) every four or five years, it's an investment in people for Manitoba."

As Klassen continues his guided tour, he moves to the sixth floor, where there is still plenty of room for more researchers. "In five years, we want this all filled up with bustling activity," says Klassen, pointing to an empty bank of lab space.

Then, bouncing back with his natural positive spin, he says: "So you can see they built this amazing space, so the pressure on me is to get the best scientists working here, but this is a phenomenal recruitment tool because it's very attractive."

Even with his abundance of positive energy, Klassen knows the task ahead is daunting. "I want to get the brightest and the best," says Klassen. "I want to create an environment where people will want to come. I saw it happen at Stollery. Once you get the momentum going - people want to be there."

Dolores Haggarty is a Winnipeg writer.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the May / June 2011 issue of Wave