An international health guru

Paediatrics, health management, teaching international health at Harvard—how did it all start?

After a traditional path through medical school and specialist training in paediatrics, my wife and I decided to go around the world for some freedom and excitement. We went to Tanzania where I practised paediatrics for 18 months in a rural hospital. Since the largest cause of death there was measles, I realised that if I were to have any impact on health, my clinical skills were not enough. I needed to help make sure every child in Tanzania was immunised for measles with vaccines that were potent. This is what changed my views and my path.

Where did you go from there?

My wife accepted a position at the University of Papua New Guinea and it was my turn to follow her. While looking for work there, I wrote a proposal for the development of an urban clinic system in the capital city, Port Moresby. Because the Asian Development Bank funded my project, I suddenly became quite popular in the Ministry of Health and got a job as assistant secretary of health for the next three years.

I returned to the United States to study for a master of business administration and then worked for 12 years as an international health consultant at Management Sciences for Health, a not for profit consulting firm. During those years, I lived in the US, Indonesia, and Mexico, and worked in approximately 20 countries doing consulting. From there, I moved to the Harvard School of Public Health where I have been teaching and working in international health for the past seven years.

What made you take this path in medicine?

While I enjoyed clinical medicine, what I liked even better was systems analysis: understanding what prevents health systems from functioning better, and what approaches might improve them. Medicine in the US today is about following pathways and guidelines, and I am better at being creative than following preset guidelines. International health was, for me, a better match. I still use my clinical background and my knowledge of how doctors and patients think.

What do international health specialists do?

I get paid to travel around the world and work with dedicated, interesting people on the improvement of worldwide health. I go out to rural areas to see the primary care system, and work with healthcare providers, governments, international agencies, such as the United Nations or the World Bank. I go into the field, explore the health system, and then propose acceptable solutions. For instance, I am now in Pakistan working on ways that the national tuberculosis programme can support the overall health system. This part of my job is research and consulting in developing countries. The other part is that of a teacher for courses in programme management and evaluation. I feel very lucky to have the opportunity to influence eager, intelligent students.

You have a varied career—what is the thing you enjoy most?

Going to a new country and figuring out their health system, what is working well and what needs fixing. And then trying to fix it.

What is your greatest goal?

To change the world. To apply knowledge, technology, and common sense to improve the way that health providers in poor countries diagnose and treat their patients. To eliminate unnecessary deaths from diseases that are easily treated if health workers knew what to do and had inexpensive drugs to treat them. How many children in Europe or the US die from diarrhoea or pneumonia? Yet these are the greatest causes of child death in the world. If we can reduce these, we can change the world.

If you had one thing to tell your students, what would it be?

Don't ever lose your idealism to make the world a better place. As we look to our future, we must also accept a responsibility for the future of those who don't have the choices we have, and try to do our part for them to have more opportunities for health, wealth, and choice. As physicians, we have a responsibility to make the world a better place than it is today so that everyone, not just the privileged few, can share in its potential.

What is the greatest lesson you have learnt?

Balance. Life is not a sprint, it is a marathon. If you want to succeed you have to pace yourself and take time for relaxing, for being with your family, for enjoying things other than work. Otherwise you burn out quickly and often lose the ability to put what you are trying to accomplish into perspective.