Reaching (way) out
MGH doctor takes fight for healthcare, rights overseas
What you see pictured on this page is the copper jacket of a bullet transformed into a cross by a man named Michael. Michael lives in Monrovia, the capital of Liberia. He lost a leg and a foot in the vicious civil wars that rolled through the country in waves from 1980 to 2003.
Michael converts these fragments of carnage into symbols of hope and sells them for a dollar each to feed his family.
Tom Burke gave me one. He's the guy in the other picture who ran into Michael as Michael pounded copper on a street in Monrovia late one evening last year. Burke has been in Liberia countless times since he founded something now called the Massachusetts General Hospital Division of Global Health and Human Rights in late 2006.
This outfit is one of the few hospital-based global health centers in the country. Its goal is obvious, given its name: to improve healthcare and human rights in poor countries, including the fight against global trafficking of sex slaves. (His plan is to teach healthcare workers to recognize sex slaves when they come in with infectious diseases and work with authorities to free them.)
I confess that my eyes glaze over at the legions of do-good outfits performing stupendous acts of humanity in Africa, but Dr. Thomas F. Burke caught my eye. He was approached by the presidents of both Liberia and Zambia to alleviate the deplorable quality of pediatric and maternal care in their respective countries.
Guess how many pediatricians there were in Liberia when he began work? Try zero. Nearly 1 in 4 children there will die by the age of 5.
In Zambia, 10 percent of newborns will die within the first 28 days of life. It goes on.
Liberia teems with the walking wounded after years of war. "Everybody has PTSD," says Burke. To address this situation, he and his team are writing policy for mental health treatment in the country. "Our goal is to train psychiatrists and community-based therapists."
From the start, Burke envisioned a transitional strategy where he and his troops would teach Liberians and Zambians to train themselves as doctors, nurses, midwives, and then vamoose to other countries in need. His goal is, in his words, "to be obsolete in 10 years."
His organization began this training effort in Monrovia last July. There are now two Liberian pediatric residents, three pediatric interns, and a few medical students rotating through from a depleted medical school in Monrovia.
On the other hand, there are now between two and five pediatricians from Burke's group in Liberia at any give time all year. In all, 55 doctors were clinically involved in both countries thus far, 22 pediatricians in Liberia alone. They come from the MGH, the Brigham, Children's, UMass Medical School, the University of Washington, the University College of London.
Some spend a month or so of their vacation time there; others stay for three months or more. Some are doctors, some residents, while others are professors from academic centers here who come to teach.
"People who do this are usually people in their late twenties or early thirties, or the kids are gone or they're retired," says Burke.
I like Burke, a Wenham native, because he's a mensch and because he's got a lot of skin in his own game. He donates 80 percent of his take home pay - not pretax salary - to the center. There may be others out there who take this kind of hit, but I've never met them.
A divorced man with no kids, he lives in spartan fashion and devotes his life to this cause. Only people untethered from family life can make this kind of commitment. They are the engines driving countless relief efforts, but they live single-bore lives.
Burke, 46, was an interesting bird long before he started the Division of Global Health and Human Rights. Trained in emergency medicine, he was an Army doctor for seven years. During that time, he helped build a health plan in 1994 to care for the 28,000 Cuban refugees at Guantanamo.
He directed the emergency department at Landstuhl Regional Medical Center in Germany, our largest military hospital outside the country, during the Bosnian crisis. He was the doctor attached to the FBI hostage rescue teams at Waco and Ruby Ridge.
By now, everyone knows what happened at these places, and it would take up gobs of space explaining each one.
He has been a senior emergency room doctor for years at the Brigham and now the MGH. The guy has been around. The kumbaya in his soul is tempered by hard experience on the ground.
His organization depends on the kindness of strangers to survive. Foundations and private philanthropy have been anchors to meet its measly $1.6 million annual budget.
It gets in-kind services: The MGH, for example, donated $250,000 in equipment to the operating room Burke is building in Zambia.
He chafes at lost opportunities of other outfits to target those in need. "There is a misalignment of incentives," he says. Rather than devote money to population-based solutions, many organizations - UN agencies are prime examples - spend a great deal on process, he maintains.
More than 80 percent of USAID funds earmarked for help overseas never leave this country, he adds, but instead feed the huge industry here backstopping global relief efforts.
When he's not traveling to Africa, Burke remains in near daily touch with both operations from Boston.
He pauses during our interview to say, "We saved five kids today - three newborns and two infants with pneumonia."
Not a bad day.
Sam Allis can be reached at firstname.lastname@example.org.