What is your hometown?
I was born right outside Chicago, Illinois, but was raised in Ames, Iowa. I graduated from Ames High School in 1982, and attended St. Olaf College in Minnesota. I have solid Midwest connections!
How/when did you become interested in science and medicine?
My interest in science is long standing, as my father was a math teacher and from early on instilled in me an interest in scientific inquiry. I took all the honors level courses I could in high school and decided to major in chemistry in college. While in college, I spent a summer working in a Palo Alto laboratory making monoclonal antibodies, and I decided that my career was not headed toward laboratory science. I was too interested in being out in the field, interacting with different people and hearing about their health problems. St. Olaf College has a strong pre-medical track as well as a strong chemistry department, and in my second year I choose pre-medicine much to the consternation of my chemistry professors. But I felt it opened up many more possibilities for the future.
What interested you to pursue a career in medicine and medical education?
When I was younger my parents had several friends who were physicians who probably put the idea in my head that I could become a doctor. One otolaryngologist in particular had traveled the world, and spoke quietly but wisely about the health problems in developing countries. After deciding against a career in chemistry I went full steam ahead with pre-med studies, and minored in religion. I had heard medical schools were looking for well rounded individuals, and coming from a liberal arts college it wasn’t hard to take courses in literature, religion, and music to round out my global education. I finished my pre-med requirements after three years, and spent my senior year taking courses in four countries around the world on a study abroad program - Egypt, India, Taiwan, and Japan. The health problems in India struck me as enormous, and something one could spend their life working to ameliorate. I became a humanitarian during that trip, and it was then that I decided to pursue international health as a career. I couldn’t get enough of traveling.
As a graduate of the UI Carver College of Medicine, what does being the recipient of the Distinguished Alumni Award mean to you?
To me it means a validation of doing international health work from a local perspective, and recognition of the aspiration shared by millions around the world to achieve social justice in health. When I was a young medical student, I became inspired by the dictum to “Think globally, and act locally” to improve people’s health. But later, when I realized the interconnectedness of our actions on the health of people in all nations, in my case I changed this to “Think globally and locally, and act globally and locally.” Personally, this has ushered me into a career in international health. I have been working to address the world’s drug-resistant tuberculosis problem, but also manage TB patients in Atlanta. I am a commissioned officer in the US Public Health Service and am available 24 hours a day to respond to all health emergencies that affect American citizens, but I also work with an NGO that serves the poor and marginalized in Central America and Africa. Nothing is stopping us from caring about the health of our fellow global citizens on the macro level, as well as working to improve the collective well being of our neighbors and community members.
Please highlight your major career achievements, awards, discoveries, etc.
Reflecting upon the last 15 years of work, the first thing that my colleagues and I accomplished was forming a non-governmental organization that works for social justice, health, and human rights in developing countries. We call the organization Doctors for Global Health (www.dghonline.org), but it is really a very inclusive group that includes all health professionals, teachers, computer programmers and others. We are in our 15th year of operation, and now have projects running in El Salvador, Nicaragua, Mexico, Peru, Uganda, and the United States. Due to work constraints I am no longer a board member, but I remain involved with the organization.
Second, during my first few years with the Centers for Disease Control and Prevention (CDC), we performed a study in Malawi that showed that the social marketing strategy to get insecticide treated bed nets out into the community to prevent malaria transmission was not working. The cost of the bed nets was too high for the poor to afford. This, and other work, led to an international consensus to make bed nets part of a primary care package for the poor, just as vaccines and tuberculosis (TB) care are free.
Third, probably the work with the biggest impact has been engaging with colleagues internationally in the fight against drug-resistant TB. I was part of a small CDC/World Health Organization team that established the evidence base for the working definitions of the newly coined “extensively drug-resistant TB,” or XDR TB. The acronym popped into my head one day while I was thinking of the X-Games and the X-Files. We’ve been accused of trying to “sex up” the normally stale world of international TB control, but it worked! The identification that XDR TB leads to much worse treatment outcomes than multidrug-resistant TB has led to a large increase in attention and funding for TB control globally, which will hopefully make a difference in the lives of millions of people suffering from this disease.
Lastly, I was proud to serve in the United States Public Health Service during the World Trade Center and anthrax attacks in 2001, both of which I was intimately involved in.
Is there a teacher, mentor or Carver College of Medicine faculty member who has helped shape your education?
I remember Drs. Richard Wenzel and Mary Nettleman (93MS-Preventive Medicine & Environmental Health/Epidemiology) very well. They both sponsored an elective in hospital infections when I was a senior, and I wrote a couple papers with both of them on travelers’ health and surgical wound infections. They probably did more than anyone else in cultivating my interest in epidemiology and public health. Dr. Wenzel was the first person to suggest the CDC’s Epidemic Intelligence Service (EIS) as a possible career move. I filed that in the back of my brain for many years, and it was only after working in primary care medicine for five years that I recalled his advice and applied to EIS. I was glad I did, because it was the best two years of my professional career.
How or why did you choose the University of Iowa for your education and medical training?
I was reared in Iowa and felt the need to stay close to home. In the end, it was my “travel bug” that took me out of Iowa to do my residency training, but when I reminisce about living in Iowa City I recall how cosmopolitan it really was if you knew where to look. The education was excellent, and the learning environment was very safe and nurturing. I am glad to be a graduate of the school; I still keep in touch with many friends from that time.
What kind of professional opportunities or advantages has your University of Iowa medical training provided?
Although we all "dissed" the public health and statistics classes during medical school, it’s ironic that I would ultimately end up in the field of preventive medicine and public health. The training we received in public health was truly excellent, much better than most other students get at other schools. Taking electives with the epidemiologists at the University of Iowa covertly launched me toward a career in public health that I don’t regret for one minute. I’m glad to see that there is now a school of public health at University of Iowa - it was long overdue.
Please describe your professional interests.
No matter what specific field I’ll work in within public health, it will likely always revolve around diseases of the poor and marginalized. I think it’s a crime that there is so much wealth in the world, the "have’s", and yet so much avoidable suffering among the "have-nots." The diseases that afflict the poor are not just infectious diseases; diabetes and heart disease are on the increase. Thus my interest in fulfilling what the World Health Organization calls "creating the conditions in which persons can reach the highest attainable standard of health."
How did you become interested in public health and preventive medicine?
I distinctly remember taking the public health, preventive medicine, and statistics classes during medical school; for me they were interesting because I always had a love of math. In the department, Dr. Robert Wallace had a big impact on my chosen field of medicine while I was in school. He was an example to me of how one could achieve excellence in science with a commitment to the less fortunate, and be able to look at the world of health and medicine using a global lens. I never knew I would ultimately end up in the field of preventive medicine and public health, however, for me the goal was to become a clinician and practice medicine. It was only after practicing in a community health center in Boston that I realized that public health was beckoning, and I called upon the educational foundation that I was given during my time at the University of Iowa. I thought that I could have a bigger impact on people’s health status by working at the macro level with a social justice perspective, whether doing research studies or designing health programs, or working on health policy issues at the global level.
What are some of your outside interests?
Besides learning about health and medicine, what really drove me to travel was photography. I had envisioned applying to become a National Geographic photographer, but that lifestyle does not afford the security that working in the health field does. For several years I was showing my photographs of landscapes and people in small venues, and was selling out my shows. But my free time has slipped away since then, and with small children one never has much time to pursue outside interests very much.
I also enjoy writing, and in 2009 published my book of stories about living and working in India in the 1990’s with the Tibetans in exile. The book is called “A Doctor in Little Lhasa,” and is being used in some medical school courses. It’s a short memoir of being a doctor to the Tibetan diaspora in a small Himalayan refugee town, living near to the Dalai Lama, as well as taking care of all the foreigners who flock there to see him. My other interests are hiking and camping, and it was a great place to explore the outdoors and get in some tough climbs.
Do you have an insight or philosophy that guides you in your professional work?
I’m a firm believer that the right to medical care and to “health” in general, is a right of being human. By “health” I mean the conditions necessary for people to be healthy. The preamble to the World Health Organizations’ Constitution states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” I think this more than anything keeps me going in my job and keeps me striving to do better.
If you could change one thing about the practice or business of medicine, what would it be?
I would take the profit motive out of medicine. I believe that health care is a human right, and that people should not profit on the misfortune or ill health of others. Health care professionals need to make a living of course, but they can do so while working in a humane society that guarantees medical care to all those living within it. The pharmaceutical industry, insurers, and for-profit health care corporations are sucking an enormous amount of resources out of the system purely for the benefit of their shareholders, while millions of people go without access to medical care in this country. In my opinion it’s really quite shameful. I’ve been active in Physicians for a National Health Program (PNHP) since I was a resident at Cambridge Hospital (a chief reason I trained there), working toward a single-payer health system in the United States that preserves the autonomy of physicians and allows freedom of choice for patients and families. We’re a great country, and creating this kind of system is not outside the realm of our ingenuity.
What is the biggest change you've experienced in medicine since you were a student?
The growth of the health care system’s bureaucracy, and the amount of oversight and management that is being imposed upon practitioners. I practiced primary care medicine for four years in urban Boston in the late 1990’s, and I saw the changes that managed care brought to the field of medicine. Some changes were for the better, but a great number of things got worse. Monitoring that diabetic patients have a regular hemoglobin A1C and a foot exam is an important thing, but imposing incentives on physicians is not the right way to do it. European countries have excellent health care systems and much better health indicators that the United States without all the perverse incentives. We’re all in this together, and the system should reflect that communal effort.
What one piece of advice would you give to today's medical students?
Be a dreamer and an idealist, and don’t succumb to the pressures of money making and business. Resist ties to industry and profit. There is so much suffering in the world, and each one of us can make a difference in our own small way and lead a comfortable life for our families. HIV/AIDS, TB, and malaria still kill millions of people around the world each year, and the knowledge of how to treat and prevent these diseases is out there. We need more human power to go and relieve the suffering of the poor and marginalized, both abroad and at home.
What do you see as "the future" of the medicine?
I look at the practice of medicine and public health through a global lens. Despite impressive gains and a large influx of resources into the field of international health, there are still huge challenges ahead.
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