Grand Rounds Report: Medicine for the Underserved in Africa, Far More than Primary Care

by Academy of Clinical Excellence on October 16, 2009

Dr. Rick Hodes, a former house officer at our hospital (then Baltimore City Hospitals), shared his experiences as a physician caring for literally thousands of people in Ethiopia.

Many in the audience on this day might have felt that they were at a parade, but instead of the gaiety and pageantry of colorful floats with Disney characters, patients afflicted by the most horrific maladies passed by, each evoking our curiosity as well as overwhelming sadness. We were shown examples of noma (cancrum oris) which resulted in the destruction of the faces of young people. We also saw children, permanently disfigured by the bites of hyenas. There was lamellar ichthyosis, osteosarcoma, Burkitt lymphoma, corneal opacities from measles, polio, VATER syndrome, rheumatic heart disease, and trachoma. And perhaps most spectacular were examples of more than 100 patients Dr. Hodes cares for with almost unbelievably distorted spines from TB spondylitis.

But those who watched this parade could not help but be moved by the tremendous professionalism and humanism demonstrated by a caring physician, one who has chosen to dedicate his life to those less fortunate than he, and less fortunate than most people in his native country. Dr. Hodes demonstrated his passion for, and overwhelming dedication to, those who might otherwise not get medical care. He showed how collaboration, a concept we teach our physicians in this country, is so crucial to providing outstanding care to his patients. Collaboration with Dutch plastic surgeons who offer to help these disfigured children when no one else will. Collaboration with a particularly gifted surgeon who devised an innovative approach to repairing spines distorted by tuberculosis. Collaboration with various charity organizations who donate medical supplies to Mother Teresa’s mission where Dr. Hodes’ patients find safe haven. Collaboration with the manufacturer of imatinib mesylate, who donates this drug so that Dr. Hodes can treat individuals with various cancers. Collaboration with heart surgeons in India who repair cardiac valves destroyed by rheumatic fever. Collaboration with some of the world’s leading oncologists, allowing Dr. Hodes to develop drug regimens tailored specifically to fit the needs of patients and the surrounding culture and environment as he delivers chemotherapy on his front porch. It is this collaboration and understanding of patient preferences and culture that defines the competency of “systems-based practice,” i.e., the ability to skillfully negotiate the health care system to meet the needs of our patients.

Dr. Hodes ended his talk with a quote from Theodore Roosevelt that sums things up:

“Do what you can with what you have, where you are.”

And while that certainly applies to the care Dr. Hodes provides in Mother Teresa’s mission in Ethiopia, it seems good advice to us all.

Here is a short video that provides a bit of insight into Dr. Hodes' work in Ethiopia:

*image and video from Readers Digest.

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