The Right Medicine for Global Health by Erin Peterson

hea

s in the medi e i n n cal oh J fie e v i ld F sh

hem to travel t s e the iv r d glo at h be w e to r a

sick. l the

The Right Medicine for Global Health By Erin Peterson

Most doctors are hardwired to help. They want their patients to live healthier lives. They want to make an impact in their clinics and in their communities. And for doctors who graduated from Saint John’s University, there’s often a pull to think even bigger. “Saint John’s nurtures the idea that we should be part of the larger global community, and that it’s important to make things better for those in need,” says anesthesiologist Ryan Jense ’98. “We’re asked to pursue these ideas in many different ways.” Jense isn’t the only Johnnie who feels that way. We talked to five doctors who have traveled the world to help those who need it most. Often, they say, their patients are not the only ones who benefit. 22

A Better World, One Patient at a Time Name: Walt Halloran ’80 Field: Cardiac surgery Country: Laos

When Walt Halloran ’80 visited Laos earlier this year, he was eager to use his skills as a cardiothoracic surgeon to help perform complex—and sometimes life-saving—spinal and lung surgeries. But the trip taught him that the need for his surgical expertise was just the tip of the iceberg. While Halloran worked diligently to help his patients, who had become immobilized by spinal tuberculosis, the working conditions were grim. Less than a third of the hospital had functional plumbing, and there was just one elevator that worked reliably. “Transporting the patients from the operating room to the ICU meant a trip outside and down the sidewalk,” says Halloran.

Meanwhile, patients’ families did not have the option to sit in a comfortable waiting room or eat a meal at a cafeteria. Instead, they camped outside and cooked food for themselves and their ill family members. Though the country’s health care is free to all citizens, it remains deeply underfunded. But the inconvenience to patients and their families was hardly the worst part, he says. “Many diseases we rarely see in modern cultures—malaria, dengue fever, tuberculosis—remain rampant.” Nurses and doctors, though smart and dedicated, were overwhelmed with the enormous patient load. Despite such difficult circumstances, he says he left feeling grateful. That gratitude wasn’t simply for the health care that he enjoys in the United States, but knowing that, in some way, he could make a difference half a world away. He will return again later this year, and plans to make it an annual—if not semiannual—trip. “There is simply too much to do to fix the world,” he acknowledges. “We have to start with small works like these.”

Laos

Walt Halloran ’80 with a satisfied patient in Laos, where he travels to provide complex spinal and lung surgery.

Thailand

United States

Mexico

Tom Larkin ’64 (L) with one of his cataract patients and an operating-room technician on a medical mission trip in Mexico.

A Clearer Vision of Medicine Name: Tom Larkin ’64 Field: Ophthalmology Countries: Bolivia, Mexico, Honduras Tom Larkin ’64 has been a busy eye surgeon in Denver for four decades. With the benefit of technology, he can complete a typical cataract surgery in 15 minutes with a tiny, two-millimeter incision. Within days, patients can get behind the wheel and return to their normal activities. But when he goes abroad to Bolivia, Mexico or Honduras to do the same surgeries as a volunteer, he uses a far less expensive technique that requires larger incisions and poses greater technical challenges. “I am still not totally comfortable with the less predictable working environment abroad as in our modern facility in Denver,” he says. “We expect well-trained support staff in an airconditioned operating room with expensive microscopes and cataract machines,” he says. Larkin has been traveling abroad to do cataract surgeries for nearly 30 years. He says while he may once have felt some hubris about the skills he brought as an American surgeon, he’s consistently impressed by what local doctors achieve without the benefit of space-age technology. “Patients have to be pretty careful about what they do afterwards,” he says. “But it costs less than $100.” (In the United States, a cataract surgery can bump up over $1,000.) His frequent travel abroad has helped him become

more aware of the incredibly high standards that American patients have for their health care providers—in his city alone there are more than 75 doctors who do cataract surgeries. Patients often have the luxury of choosing a doctor not simply by skill level, but by office ambiance, bedside manner and location. In many cities around the world, however, the specialists who do similar work can be counted on one hand, if they can be counted at all. It’s a privilege Americans don’t always appreciate, he says, but as our health care costs suggest, it’s one that we pay for. Nonetheless, Larkin says that for whatever shortcomings Americans might see initially with the kinds of eye surgery done abroad, the long-term results of their lower-cost surgery often rival the best of anything done in the United States. “It’s heartwarming to see patients in volunteer clinics come back after recovering with the newfound ability to read and function as they could before developing cataracts,” he says. “It is a blessing to be a small part of the universe of volunteer physicians who can travel abroad to try to make a difference.”

Solving the Problems that Medicine Can’t

can change the way that parents treat a child. A heart surgery can transform a life. But for Kevin Healy ’76, who’s traveled to 20 countries as a volunteer anesthesiologist, some of the day-to-day Name: Kevin Healy ’76 satisfaction of the work comes from the creative problemField: Anesthesiology solving required to address complications that rarely arise Countries: A number of countries in Africa, Asia, the Caribbean, Latin America and the Middle East. in American hospitals. “Maybe there’s a problem with the oxygen supply, or maybe there’s not consistent electrical power,” he says. “You might start the day with a list of five Many doctors volunteer in underdeveloped countries cases, but by 9 p.m. that night, you’ve done eight—and because they want to help those who might not otherwise only three were on your list to begin with. You’re always be able to afford good medical care. A cleft-lip operation trying to do what you need to do to serve as many people as you can.” He adds that some of the most rewarding cases are the ones that he could not have anticipated. When Healy was in India, a young girl arrived to get facial reconstruction. Just before she entered the operating room, Healy discovered that the girl, who was quite frail, was suffering from an undiagnosed heart murmur. He and the surgeon sent her to a cardiologist who fixed her heart valve. When she returned two years later to get the facial reconstruction, she’d put on muscle and was no longer short of breath. “Initially, she didn’t get the operation she wanted,” he says. “But she did get what she needed.” Healy knows he can’t help everyone who needs it, but he is philosophical about the help he does provide, relating a story he was once told about the rabbi who was asked why God created lots of cattle and birds and fish, but only one man and one woman. The answer was that one man is like all men, the rabbi said. If you harm one man, it’s as if you harm the whole human race. And if you help one man, it’s as if you’ve helped the whole human race. Africa “That really resonated with me,” he Kevin Healy ’76 induces anesthesia says. “One of these kids might play a vital in a small patient (wearing a really role in history; I just want to give every kid cute hat!) at Harare Children’s Hospital Zimbabwe the best chance I can give them.” in Zimbabwe.

Big-Picture Health Care Name: Vincent (Bob) Hunt ’56 Field: Family medicine Countries: Russia and a number of countries in the Middle East, Asia, Africa and Latin America

Bob Hunt ’56 and Chinese China colleague Dr. Li Yan-Na at a neighborhood clinic in Beijing in 1997 before it became the first pilot family-medicine teaching center. Centers like these served as nationwide models for China’s current health care restructuring. In many underdeveloped countries, a baby born today is unlikely to live to age 50. (By contrast, the average life expectancy in the United States hovers around 80.) Behind this dismal statistic is a complex stew of poverty, poor infrastructure, and inadequate health care. But for about $20 a person—the cost of a couple of movie tickets—Bob Hunt ’56 knows that these countries could lift their citizens’ life expectancy by years. Early in his career, he spent many years helping the patients in rural Minnesota live longer, healthier lives. And he has been just as committed to helping entire countries do the same. After finishing his medical internship, Hunt spent eight years working in Red Lake Falls, a tiny town in northern Minnesota. He says he was often shocked by the actions of his patients—until he took the time to understand them. “I remember farmers used to stop by and drop their wives off to deliver the kids, and I assumed

the farmers must not care about their families,” he says. “But then I understood that if they didn’t get their crops in, for example, it could wipe out their livelihood. They cared just as much about their families as anyone, but I hadn’t understood the nuances of the culture.” Good care, he realized, wasn’t just about understanding the science of the body. It was about understanding the subtleties of the community. In 1969, he took a job at the University of Minnesota to pursue work at the school’s newly developing field: family medicine. As the field grew, he began to consult for medical schools around the country who wanted to focus on this new area. In 1978, nudged by the powerful Alma-Ata Declaration, which urged countries to commit to providing primary health care to their citizens, many world leaders began thinking more seriously about how to recruit and train primary care doctors. And Hunt had developed expertise to help lead the way. In countries like Lebanon, Nicaragua and South Korea, Hunt worked through groups including the World Health Organization to understand the barriers to providing good primary care. He gave talks to medical organizations and spoke on local television to build support for primary care. And he helped build and refine familypractice residency programs from the ground up. Over time, these professionals went out into the field to deliver the inexpensive but critical health care for common issues such as pregnancy, childhood diseases and malaria. One of the lessons that guided him through all of his work was the one he learned in Red Lake Falls: to truly help other people, you must understand them first. He also takes to heart the advice given by St. Benedict, he says, to “listen with the ear of your heart.” He believes that this approach—one that integrates grass-roots support with high-level expertise—is the most effective way to create real and lasting change. Hunt acknowledges that both for him and for those he works with, it can be frustrating that the changes he tries to introduce can take years or even decades to come to fruition. His work is never as dramatic as taking out a gallbladder or repairing a cleft lip. But over time, he says, the changes can be profound. “You have to plant the seed and hope that it’s strong. You’ve got to have support from the society,” he says. “And that’s when, hopefully, you’ll see the programs flourish.”

in medical school to do much international medical work outside of taking a year off and finding your own way,” he says. “That holds true for most residents, too.” When he began work as an anesthesiologist in Washington, he made connections with local groups in Seattle who have relationships with different hospitals in Nepal Nepal and Honduras. He now works in these hospitals India Ryan Jense ’98, anesthesiologist, transcends the language as often as possible, barrier in Nepal by entertaining his young patient with a game most commonly to help on a smartphone. repair club feet and other extremity deformities in young children. Jense has been conscious about forging lasting relationships with specific hospitals, which he visits Name: Ryan Jense ’98 whenever he can. He knows he has the biggest impact Field: Anesthesiology when there is consistency and regular follow-up care in Countries: Nepal, Honduras, Guatemala international work. “You’ve got to make sure when you do this kind of medical work, you’re relieving a burden, not When Ryan Jense ’98 signed up to go on an leaving one,” he says. international medical mission to Guatemala his senior year Indeed, he finds joy in the progress he has seen at at Saint John’s, he thought it would be a great way to get a the hospitals over time. It comes in the form of grateful couple weeks of on-the-ground experience before he entered patients, who may not have been able to walk into the medical school the following fall. It turned out to be much clinic one year, but stroll in the following. It also comes more than that: it was a catalyst that has driven his career. when he sees a hospital add new equipment, build a new During this first volunteer trip, Jense accompanied wing or simply plant flowers in front of the building. a classmate’s father, Dr. Phil Boyle, to assist a group of Today, he’s working to give more young medical surgeons, obstetricians and anesthesiologists in the bustling students and residents the opportunity he got when still city of San Cristóbal. He was stunned by the relative dearth an undergraduate. As a faculty member at the University of health care and infrastructure compared to his home of Washington working in the School of Medicine’s country. Facilities were crumbling, equipment was old or departments of global health and anesthesiology, he’s nonexistent, and clean water and electricity were unreliable. pushing to grow international experiences in residency “At that stage in my life, it had such an impact on me,” he programs not only at his school, but schools across the says of the experience. “It was the first time I’d seen things nation. “People who go into medicine, they’re idealistic,” like that in person, and it instilled in me the desire to keep he says. “They want to serve, but then they get caught working with those populations.” up in the business of medicine and lose track of that. It’s As he moved through medical school and residency, important to try to keep that sentiment alive.” though, he put his dream to stay connected to international medicine on the back burner. “There wasn’t a mechanism Erin Peterson is a Twin-Cities based writer.

Taking the Long View