Many Medical College of Wisconsin alumni have contributed time and talent to improve international health care. Several practicing and aspiring physicians recently offered insight into their experiences and influences in global health.
Peter Drobac, MD ’02
Dr. Drobac is the Director of Partners In Health's (PIH) activities in Rwanda. With PIH since 2003, he is involved with program development and implementation, clinical service, teaching, management, and research. In Rwanda, PIH is helping the government to strengthen health systems by supporting comprehensive primary health care for nearly one million people in three rural districts. Dr. Drobac is also an Associate Physician of Global Health Equity and Infectious Diseases at Brigham and Women’s Hospital and an instructor of global health and social medicine at Harvard Medical School.
“Prior to medical school, while working in Tanzania as a children’s rights advocate, I met hundreds of kids living on the street, many because they had lost one or more parents to AIDS. I saw children starving, dying, beaten, burned and jailed, all for the grave crime of being poor. The same year, Partners In Health was making antiretroviral treatment available and free in destitute communities of rural Haiti. Partners In Health has come a long way since then, now with over 30 projects in 10 countries. Somehow – through begging, pleading, and stubbornness, mostly – I have been fortunate enough to play a small role. Many of the formative experiences of my residency and fellowship training occurred in Haiti, Peru, and finally Rwanda, where I have landed for the foreseeable future.
We are thinking a lot these days about how to carve out academic career paths in global health. This is important to me, as I plan to be at this for another half century or so. I am convinced that no other field in medicine is as consistently challenging or as relentlessly rewarding as global health. Global health gets to the very core of what it means to be a physician – to serve the sick and the poor, and to link that service to research, teaching and advocacy.”
Laurel M. Bear, MD ’84, GME ’87
Brian J. Bear, MD ’84, GME ’89
Laurel Bear is Assistant Professor of Pediatrics (Special Needs) at The Medical College of Wisconsin. Brian Bear is an OB/GYN in private practice in the Milwaukee area. The Bear family has traveled to the mountain villages of Honduras to provide medical services as part of Global Medical Brigades for a week each January for the past four years.
“It has been an amazing and humbling experience caring for the poor of Honduras. We have been forced to go back to the basics of medicine being limited to a history and physical exam. We have learned how important it is to the people of Honduras that we take the time to listen to them, examine them and then try to provide basic and preventive health care. Our experiences have taught us the importance of taking time with each and every patient. We have learned that no matter where you practice in the world, people want you to listen to them and address their individual needs.
Our time in Honduras has taught us that there are a few very important universal truths. Perhaps most significant is the importance of family. Although very poor, the Hondurans find joy in their family, their community and their faith. What the Honduran people want is the chance to be healthy and provide for their family. Our patients in Honduras often walked a half a day to reach us and then would wait for hours for their turn to see us. We have learned how fortunate we are that we live where there is relatively easy access to state-of-the-art health care. We have also learned the importance of public health on the overall health of a country. Access to clean water, appropriate sanitation and adequate nutrition goes a long way to improving the health of a country.”
Ann Cappellari, MD ’00
Dr. Cappellari is an emergency medicine physician at St. Agnes Hospital in Fond du Lac, Wis. In addition to previously being a Peace Corps volunteer stationed in Burkina Faso, she was a volunteer for Médecins Sans Frontières (Doctors Without Borders) in Darfur, Sudan, from October 2005 to May 2006. She supervised a 40-bed pediatric and adult hospital, emergency services, malnutrition center and outpatient clinic.
“This agrarian culture of West Darfur was so isolated, people lived in grass and mud huts without running water or the concept of latrines. Kids would touch my skin and look at their hand to see if the white would rub off. Their practice of medicine was a craft passed down through the ages. Residents would invariably visit the local healer prior to seeing us: Pull the teeth to treat diarrhea in children, burn the scalp for headaches, cow dung for bee stings, and small fine scarring for abdominal pain. Diseases I’ll never see again were routine: neonatal and adult tetanus, rabies, hepatitis E epidemic, malaria, leprosy, some of which we could cure. For others, we were no more effective than traditional scarification.
Has this experience changed my medical practice? The diagnostic dilemmas challenged me, relying on an outdated Cecil’s text to tell me why one man is urinating milk (answer below). The death, war and poverty remain haunting. Little things now vex me, like the teenager who ‘just can’t swallow pills,’ when you can be sure the mother of the infant with malaria will get that child, by any means, to take the medicine. What I really hope is that my experience can change you. Think strongly about volunteering. Go now, before you have a family; go later, after your career is established. Take the incredible privilege of being a medical doctor and change a corner of the world. (Chyluria from filariasis)”
Patrick G. Cudahy, Class of 2010
Cudahy is an M4 at The Medical College of Wisconsin. From July 2008 to April 2009, he worked in Pietermaritzburg, South Africa, at a large district hospital with an American NGO on HIV and tuberculosis research. His first international health experience was in the summer of 2006 after his M1 year. He traveled to Bungoma, Kenya, for a month of work with mobile medical clinics. Cudahy plans to pursue medicine or medicine-pediatrics with a subspecialty in infectious diseases.
“One weekend while in South Africa, I once drove forty minutes to my friend Sandile’s house in a rural township. He lives in a mud hut with a grass roof and keeps a few cows, goats and chickens. It was totally different than anything I knew, and yet we spent that afternoon in his hut watching soccer and drinking a few beers. Hanging out with a Zulu tended to be a lot like hanging out in Milwaukee. People ask me what crazy diseases I saw over there but most of what I saw was troublingly ordinary: case after case of HIV and tuberculosis. The difference was how advanced the disease was when diagnosed and how little we could do. These were not exotic African diseases, but diseases of poverty. The burden is immense, and there are shockingly few people doing anything about it.
I literally dream of returning to Sandile and Bheki and Gugu and all the amazing people I met over there, in order to continue my work. My first question to residency directors during interviews will be, ‘how can you help me get back there?’”
Dr. Drobac’s path to global health
Peter Drobac, MD ’02, (fourth from left) is pictured with his mentor, Dr. Paul Farmer (far left), founder of Partners In Health (PIH). Also pictured are Thierry Mungwakuzwe (far right) and two former patients who now work for PIH.
“Fifteen years ago, driven by naïve aspiration rather than altruism, I traveled from Madison, Wisconsin to Tanzania to study primates.
Now I don’t want to badmouth the monkeys. They were a very resourceful lot, able to maintain social networks without cell phones or Facebook accounts; when hunting, they worked together in order to outwit and devour their prey; and they demonstrated an admirable commitment to family—at least when not committing infanticide.
Yet, much to my surprise, it turned out that those primates who walked on two legs were far more interesting. So I decided to ditch the quadrupeds… or so I thought. My next job entailed working for a group of quadrupeds aspiring to someday become bipeds—in other words, children.
Returning to Tanzania to work as a children’s rights advocate, I met hundreds of kids living on the street, many because they had lost one or more parents to AIDS. Some were themselves HIV positive. I saw children starving, dying, beaten, burned and jailed, all for the grave crime of being poor.
This was the same year that combination antiretroviral treatment—the so-called AIDS cocktail—was turning HIV from a death sentence to a chronic disease… at least in rich countries. These kids’ parents had died because HIV treatment was deemed too expensive and too complicated for Africa. This was not the assessment of those dying, or caring for dying loved ones, in Africa, but by the public health elite in Washington, New York, Geneva. By the decade’s end over 10 million children would be orphaned, and a generation wiped out, yet it registered hardly a peep worldwide.
Having never witnessed such deep injustices, I was angry. Angry, but lacking a framework to understand what I had witnessed.
I returned home to begin medical school, determined to do something about this. But where to begin? Ten years ago, there was little in the way of global health mentorship (thankfully that has changed). Somewhere along the way I stumbled upon a book by medical anthropologist Paul Farmer. He used terms like structural violence, or how political and economic forces impact the lives of the poor—mostly to detrimental effect. He described how poverty gets into the body and causes disease. The book gave me a language for my anger. More importantly, Dr. Farmer refused to compromise and accept a double standard for the poor. The same year that I first encountered those children in Tanzania, Partners In Health was making antiretroviral treatment available and free in destitute communities of rural Haiti. They called it the HIV Equity Project, and it was probably the first of its kind in the world.
Partners In Health has come a long way since then, now with over 30 projects in 10 countries. Somehow—through begging, pleading, and stubbornness, mostly—I have been fortunate enough to play a small role. Many of the formative experiences of my residency and fellowship training occurred in Haiti, Peru, and finally Rwanda, where I have landed for the foreseeable future. We are thinking a lot these days about how to carve out academic career paths in global health. This is important to me, as I plan to be at this for another half century or so.
I am convinced that no other field in medicine is as consistently challenging or as relentlessly rewarding as global health. Global health gets to the very core of what it means to be a physician—to serve the sick and the poor, and to link that service to research, teaching and advocacy. I do feel fortunate to convey that there is no better job than my job.”
View the entire fall 2009 issue of Alumni News. (opens as a pdf)
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