RALEIGH — Libby Puckett earned her medical stripes in the trenches as a physical therapist, helping victims of stroke and heart attacks regain as much of their former lives as possible.

That experience instilled in her a passion for preventing catastrophic health events that fueled her fight to prevent strokes and heart attacks among North Carolinians for nearly 20 years.

Puckett, a native of South Africa, was founding director of the state’s Justus-Warren Heart Disease and Stroke Prevention Task Force. During her tenure there, the number of heart attack and stroke deaths in the state decreased by more than 30 percent – despite the rise in risk factors such as obesity. The task force became a national model for such prevention efforts.

Puckett, 71, still works with the group on writing and administering its federal grants and is now working to ensure its survival. The task force is one of dozens of boards and commissions on the chopping block in a cost-cutting measure proposed by state legislative leaders last week.

Those who have worked with Puckett cite her ability to bring together different groups – from nonprofits to government agencies to businesses – to work more effectively toward the common goal, as well as her passion for the job.

“Libby is not only a great administrator, but she is just as ardent as she can be about cardiovascular disease in North Carolina,” says Dr. James Stackhouse, a Goldsboro doctor and former task force member. “I can think of no one else who’s had the kind of impact she has on the state level in that arena.”

She has done that in a variety of ways, such as pulling hospitals together to create registries of heart attack and stroke victims, working with county EMS offices on providing the best care for stroke victims, and persuading grocers and restaurants to mark food as heart healthy.

She has focused much of her attention on strokes, which receive less attention than heart attacks. Only in the past few decades has a treatment been developed to help stroke victims. The prevention side is the same for stroke and cardiovascular diseases: eat well, exercise and don’t smoke.

“Part of my job has been battling for understanding that heart disease and stroke are preventable conditions,” she says. “If we can prevent stroke, we can save lives, save people from disabilities, and save money.”

Leaving South Africa

Puckett grew up in Cape Town, where her father was a farmer who spent much of her childhood fighting with the Allies during World War II. Puckett graduated high school at 16 and hoped to go to medical school. But her father’s early death made it difficult for her family to afford such a lengthy education.

So she studied to become a physical therapist, and worked briefly in South Africa before deciding to leave the country for political reasons. The post-war nationalist government was instituting a series of repressive measures, including its infamous legalized racial divides.

“I was very anti-discrimination,” she says. “A lot of English-speaking South Africans were, but some of them professed to not like these policies but found it quite comfortable to have inexpensive servants.”

Her own household had a full staff; her mother, upon hearing her plan to leave the country, said she’d never cope without servants.

Puckett need to find a job so that she could emigrate legally and landed one at a hospital in Cleveland, a city she had never even heard of. She arrived there in December 1962, driving with a friend through the first snowfall she’d ever seen.

She worked at several hospitals and eventually settled down in Washington, D.C., where she married a lawyer and raised her two sons.

During that time, she began serving on the board of Children’s National Medical Center, which she says opened her eyes to the importance of disease prevention. That conviction was only deepened when she returned to physical therapy after her divorce.

“Here I was as a physical therapist trying to rehabilitate and restore function after an experience like a stroke, and you make very small gains for a lot of time and effort and patients,” she says. “I’d seen how devastating this was to families and caregivers, and it shocked me to learn that 80 percent of strokes were preventable.”

She went on to a job with Fairfax Hospital in promoting community health. Through that job and her work as a longtime board member at D.C.’s Children’s Hospital, she got used to working with government to achieve public health goals.

She moved to North Carolina in the early 1990s with her second husband, who she met at a biomedical ethics conference. (“It’s better than a singles bar,” she jokes.) A former dean at Duke University’s medical school, her husband is now retired and suffering from Parkinson’s disease.

The ‘stroke belt’

She started as the first director of a state task force created to cut the number of heart attack and stroke deaths.

The area that covers coastal North Carolina, South Carolina and Georgia is known as the buckle of the stroke belt – the area with the most concentrated number of strokes from among a wider belt of high stroke rates that runs across the Southeast.

She quickly worked to pull together interested parties, and that coordination helped her to attract federal grants. North Carolina became one of the first in the country to get funding from the Center for Disease Control and prevention for stroke prevention, for instance.

She also pulled together hospitals to keep better statistics and standardize care across the state, including rural areas. She also helped form a multi-state cooperative that is starting to use those practices across the Southeast.

And while her task force has produced public information campaigns, her focus has been largely on changing the systems that can create healthy environments: getting food producers to reduce sodium levels in food, for example, and pushing to keep smoking out of public places.

“You spend about two percent of your life in a doctor’s office,” she says. “The rest of a time you spend in a community that is either healthy or not.”

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