March 8, 2014

New Mecklenburg health director sheds white coat to explore root causes of illnesses

His grandfather in England was a doctor, a pathologist, who showed him the allure of medicine.

His grandfather in England was a doctor, a pathologist, who showed him the allure of medicine.

His uncle was a Catholic priest in the Sicilian village of Piana degli Albanesi, Italy. When Marcus Plescia, Mecklenburg County’s new public health director, traveled with his family to that village as a boy, Uncle Stefano insisted Marcus and his younger brother come along on daily visits to the sick and infirmed.

Both men would have a profound influence on Plescia’s career path.

“I really admired my grandfather and how he used medicine to improve the lives of people in his community,” Plescia said last week as he continued to meet his department’s 500 employees who provide child immunizations, investigate disease outbreaks and inspect restaurants and environmental threats.

“The life of my uncle was about helping people, too, going to their homes and healing their souls.”

Plescia (pronounced: PleSHA) has aspired for much the same kind of life – bringing health care to those who find it most difficult to access. In many ways he’s spent much of his 51 years preparing for this moment.

At every stop, from medical school at UNC Chapel Hill to the Centers for Disease Control and Prevention, where he ran a cancer prevention program, he’s sought to take his medicine into underserved areas. He doctored AIDS patients in the South Bronx, N.Y., a symbol of urban decay, during his residency training in the early 1990s and spent weeklong stints as a doctor on the Cherokee reservation in Western North Carolina while he was at the CDC.

“Marcus has always been motivated to provide care for people with fewer resources,” said Dr. Beat (pronounced Bay-ot) Steiner, a UNC medical school faculty member who’s known Plescia since they were seniors at Chapel Hill High.

“He’s not driven by a position but by where he can make a difference. Not many medical students want to go to the South Bronx to train for residency. But it fit who he’s always been.”

Passion for public health

Plescia spent his early life in Tallahassee, Fla., where his Italian father, Joseph Plescia, taught classics at Florida State University and his British mother, Gillian Lane-Plescia, was a voice and dialect coach.

At age 15 in 1978, his parents divorced, and he and brother Stephen moved to Chapel Hill with their mother, hired by UNC’s drama department to coach dialect.

It was Marcus’ first whiff of North Carolina. “Chapel Hill was a bit of fresh air,” he said. “I really started to thrive academically there.”

He didn’t grow up wanting to be a doctor, though the sciences came easy. He romanticized about the life of an architect but decided that “would have been a complete disaster.” He considered becoming a veterinarian until someone told him it’d take longer than becoming a doctor, his mother said. She recalls him considering becoming a forester.

At UNC, her son pursued a biology degree and began to think about medical school. “From my grandfather, I got that medicine was a good outlet for a scientific background,” he said.

His senior year, he decided to pursue a program at UNC that would earn him an MD and master’s in public health. Taking a year off before starting, he met Ruth Ann Grissom, a UNC senior who grew up on a Montgomery County farm. She could see then that he probably wouldn’t end up wearing a white coat and stethoscope.

“From the outset ... I knew he had a real passion for public health,” said Grissom, a writer and conservationist. “He’s always enjoyed helping people stay healthy – more than taking care of them in the hospital.”

During his third year of medical school, they married. After a year in his master’s program, Plescia returned to medical school for his fourth year bent on a career in public health. A mentor, Dr. Cecil Sheps, a Canadian faculty member who’d helped shape that country’s universal access to health care, urged him to get residency training.

Helping the underserved

Through Sheps, he went to Montefiore Medical Center in the Bronx and quickly volunteered to staff a clinic in the South Bronx.

By the early 1990s, Plescia found an area beginning to reverse its image as the country’s worst slum with burned-out tenements, extreme poverty, violence and a public health crisis that included a large AIDS-infected population, obesity and the rampant diabetes and heart disease found in many poor areas.

There he also found frustration – but his calling.

“I felt like I was at the far end of a wide-open spigot – you just couldn’t turn it off,” Plescia said. “... You’d get someone sorted out and someone else would come in. I felt like we did a lot of good for some people, but in the scheme of things to really make a difference, you needed to get out front. I wanted to help deal with the root issues.”

After his residency, he remained in the South Bronx for two years, then he and Grissom moved to Charlotte for the first time, where Plescia was a family medicine physician at Carolinas Medical Center and a UNC medical school faculty member.

About that time, CMC was building clinics in west and east Charlotte, closer to the city’s greatest concentration of Medicaid-eligible residents. Plescia quickly volunteered to help start CMC-Biddle Point on Beatties Ford Road and take his practice there. He also supervised young doctors interested in connecting primary care to public health in communities where care is less accessible.

Dr. Mary Hall, who oversaw CMC’s family medicine residents, remembers a young Dr. Plescia “looking for opportunities.”

“Marcus didn’t want to just settle into the traditional setting. He wanted to do something that would make a difference,” said Hall, now Carolinas Healthcare System’s interim chief academic officer. “He absolutely believed in his heart and soul that everyone deserves quality health care.”

Plescia immediately sought help from community leaders. “He knew you didn’t just go out to Biddle Point and wait for patients to come in,” Hall said. “You had to go out into the community.”

The leaders introduced him to the westside. “If they hadn’t,” he said, “I’d have fallen flat on my face.”

In 1999, Plescia helped secure a CDC grant that infused $1 million a year for seven years to build a community primary care demonstration project addressing racial and ethnic disparities in Charlotte. The project focused on diabetes and heart disease on the westside.

“We had a target population of about 20,000 people, and I thought finally we had the scale of funding that you need to take on these pervasive issues,” he said.

He began working with the health department and community leaders to develop a plan of health interventions.

“The message was simple: Here are the things you need to do to stay healthy, or if you have something like diabetes, to control it,” Plescia said. “We made significant health improvements there.”

After eight years, he became the chronic disease and injury chief for the state public health division in Raleigh. Then in 2009, he took the job at the CDC in Atlanta, “a pinnacle” for anyone interested in public health.

Health departments changing

Yet five years later, he heard that Wynn Mabry was retiring as Mecklenburg health director and put the word out that he’d be interested in returning to Charlotte.

After all his experiences, he wanted to lead a public health department that tackled health issues.

He said he believes the functions of health departments will change as medical care becomes more accessible under the federal Affordable Care Act.

In the past, the poor found medical care at health departments. The new health department, he said, will be more about prevention and helping set policy to promote a healthier community. As examples, he uses raising prices on tobacco products or banning sugary drinks that have been tried in some cities.

“We’ll still have an important role in prevention through immunizations, cancer screenings and family planning,” he said. “But because more people are covered by insurance through the ACA, there’s an easier path into the traditional medical care setting.”

Five weeks into his new job, he thinks about the meaningful lives his grandfather and uncle the priest lived, and he’s found satisfaction in his own.

“As a physician, I hoped to improve the health of my patients, but I also believed historical, social and economic issues often affected their health, issues that can’t be addressed within the four walls of a doctor’s office,” he said. “At the CDC, I led this fairly discrete but important unit. But here I feel I have a chance to chart the course and really make a difference.

“There’s some social value to what I do and that’s what satisfies me.”

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