The Bioethics of Infectious Disease and Bioterror: A Medical Student's Perspective
Written By: Drew Lee
November 2009

 

You know a doctor is doing great things when the cashier at the airport, workers at the post office and ordinary people on the street tell you how their life or a family member's life was saved by that doctor. I guess this is what I should have expected when shadowing Dr. Rick Hodes, who has spent the last two decades practicing in Ethiopia, with additional projects in Zaire, Albania, Tanzania, Somalia and Rwanda, and was recently a finalist for "Championing Children" of "CNN Heroes." During my two weeks with Dr. Rick, as he is simply called in Ethiopia, I was able to live with his family, visit patients, as well as gain insight into the nature of long-term international medicine.

In a country where the average yearly income is about $800 (GDP per capita), a GNI of $180 per capita, and with only 1 doctor for every 31,000 people1-3, Dr. Rick plays a very important medical role in Ethiopia. As a graduate of the University of Rochester Medical School and completing his internal medicine residency at Johns Hopkins University, Dr. Rick could have led a lavish life practicing in the United States. However, after spending 2 1/2 years in Ethiopia in 1985 as a Fulbright lecturer, Dr. Rick returned in 1990, as the director of the American Jewish Joint Distribution Committee (JDC) medical program in Ethiopia.

Since the early 1990s, Dr. Rick began volunteering at Mother Theresa's Mission (MTM) in Addis Ababa, "treating those that no one else would treat." Since then, his work at MTM has become part of his official duties with the JDC. Although trained in internal medicine, being the only Western doctor at MTM, Dr. Rick is now also a specialist in heart disease, spine disease, and cancer. With 20+ years experience in Ethiopia, Dr. Rick has become an expert in illnesses such as spinal TB, cardiac diseases, scoliosis, etc. Although he does not advertise his work, he receives about 20 patients daily who hear about his work from previous patients or by referrals from other physicians who send some of their worst cases. Working in a place like Ethiopia is not easy to say the least; in addition to treating patients that have diseases that have progressed to extreme conditions, there are also random electrical blackouts, lack of medicines, very slow internet, lack of diagnostic experts and medical equipments, and not to mention the lack of patient funds for medical treatment. As a result, Dr. Rick pays for most of the x-rays, EKGs, blood test, etc. and has developed an "electronic record" by just using his laptop and digital camera to keep track of his patients' information and test results.

Even after a hard day's work, Dr. Rick spends time conversing with his patients. Dr. Rick is standing with Anesew, who was successfully treated for Hodgkin's disease and returned back to his village a few days after this picture was taken.

With this information, Dr. Rick has also developed an extensive network to provide the best care to his patients- contracting with local clinics, working with regional doctors, importing drugs from India, sending biopsies to the US, consulting with experts abroad, as well as sending patients to Ghana, India and the US for surgeries not available in Ethiopia.

Dr. Rick's influence extends far beyond just his medical work. He is a single father of 5 officially adopted Ethiopian children and has anywhere from 10 - 20 other Ethiopian children living with him in two houses that he rents. Before meeting Dr. Rick, many of his children were orphans, beggars or shoe shine boys with severe medical conditions, living on the street, trying to make just enough money to buy something to eat. After moving in with Dr. Rick, they are able to receive medical treatment, an education, and a safe place to grow up. Three of his adopted children are now studying in the US, while those still in Addis Ababa tell me they want to become doctors, farmers, dentists, accountants, astronomers, teachers; these dreams would have once seemed out-of-reach, but are now a possibility due to Dr. Rick's positive influence.

Asmera Lewiu, one of Dr. Rick's daughters, was living in Gondor Hospital for 3 years from the age of 9-11 when he met her, as her parents had died and she had nowhere to go. Dr. Rick then took her to MTM where she lived for a year, while receiving treatment for TB of the spine. She was eventually sent to Ghana where she received a successful spinal surgery and is now a 13-year-old living with the other Dr. Rick's children. Asmera is now in the 4th grade, is ranked near the top of her class, and has aspirations of going to America to become "a medical doctor like Dr. Rick." This is a long way from where Asmera was just a few years ago as she told me, "Before I just wanted to be a house maid so that I can have a place to stay and eat."

Dr. Rick also contributes to the education of Western physicians by sending rare cases via DVD to teaching hospitals around the world, as well as hosting several medical students a year, passing on two decades of knowledge that probably cannot be obtained first-hand from many other people. In Ethiopia, Dr. Rick taught me the importance of relying on the physical exam to make a diagnosis- to see, hear and touch the patients- rather than on technology, which was often not available. In addition to all the medical knowledge I learned during my short two-week stay with Dr. Rick, I also learned that there are many important aspects of international health that must be addressed in order to adequately meet the health needs of the patients.

Obvious as it may seem, language and culture are probably two of the biggest non-medical barriers to effective long-term medical care in a foreign country, but are rarely addressed properly by foreign physicians. In a country like Ethiopia with a relatively recent history of foreign intervention, patients may be cautious about foreign-looking doctors; speaking some Amharic or using a translator is useful to connecting with the patient and putting the patient at ease. And though one many not be able to master the language, the more one knows, the easier it becomes to establish the doctor-patient relationship. Moreover, in Ethiopia, where people believe that incising the eyelids will cure eye disease, smelling match smoke will cure epilepsy, or smearing cow dung on the head will fight ringworm,4-5 it becomes very important to be cognizant of cultural practices in order to properly treat the patient. However, it is often very difficult for a physician to adequately understand the language and culture of a people during a short-term medical trip. Even though the physician may be able to heal noticeable medical problems, they will probably not be able to effect long-term change upon health behavior or the underlying social determinants of health. However, this is not to say that short-term work is not important; but rather that visiting medical teams should look to incorporate the expertise of long-term physicians of that particular country.

In a place like Ethiopia, there are an infinite number of things to get done medically as well as socially. From treating patients who no one else can or may be willing to treat, adopting Ethiopian children, to fundraising to help pay for medical procedures and school tuition for his patients, Dr. Rick has done it all for the past two decades. Even during my short time in Ethiopia, I've seen a 10-year-old girl brought back from US after cardiac surgery and a 5-year-old boy sent to the US for cardiac surgery. Although Dr. Rick finds great inspiration through his faith, his motto of "Don't say no" towards his patients has often interrupted him from leading an ordinary life. However, Dr. Rick will tell you that even if he wanted to cure every disease, send every patient abroad for surgery, or adopt every child in Ethiopia, it is just not possible. Instead, Dr. Rick works one patient at a time, one day at a time, and the days have already accumulated to 20+ years in Ethiopia. When his house lights are finally turned off in the wee hours of the night, Dr. Rick knows that even though he is exhausted, tomorrow will be a new day that "God has given me the opportunity to save those no one else is saving."

About the Author

Drew Lee is a second year medical student at the Stritch School of Medicine. Drew would like to thank Dr. Rick and his family for allowing him into their home and their personal lives, as well as Dr. Rick's assistants, Ashenafi Yoseph and Bayelign Mamo for escorting him around Addis Ababa. Drew's trip was partially funded by donations from the Yoo and Yoon families.

To donate or get involved with Dr. Rick's work, please feel free to send Drew an email-
DLee15@LUMC.edu

For additional information about Dr. Rick:
Making the Crooked Straight- www.makingthecrookedstraight.org

References

1. UNICEF, The State of the World's Children 2008. (New York: Hatteras Press, Inc., 2007).
2. World Health Organization, World Health Statistics 2008 (Geneva: WHO Press, 2008).
3. CIA World Factbook, Ethiopia.
4. Richard M. Hodes "Cross-cultural Medicine and Diverse Health Beliefs- Ethiopians Abroad." West J Med 166, no. 1 (1997): 29-36.
5. David Werner. Where There is No Doctor- For Ethiopia (Addis Ababa: Shama Books, 2001).