Peace Talks with Harriet Fulbright

The Politics of Health Care

Leaders in Unexpected Places

by Harriet Mayor Fulbright

Photo by Edward Keating

(Editor’s Note: This is the third in a series of  Wednesday talks with Harriet Mayor Fulbright, President and Founder of the J. William and Harriet Fulbright Center.  This talk took place at the University of Washington, Seattle where Mrs. Fulbright received the 2009 Global Health Consortium Distinguished Service Award.)

Having fought some serious health problems, I am fully aware of the importance of first rate health care delivered by medical specialists who listen to patients carefully and keep up with the steady stream of new information in their chosen fields. I have been the recipient of inspired care so it gives me great pleasure to give it the recognition it deserves. These are doctors who have great skill as social entrepreneurs, and their kind springs up in all countries. They are people who are not satisfied with current practices in their professions and lead in the development of innovative solutions for seemingly insurmountable obstacles.

Dr. Devi Prasad Setty is one such entrepreneur. He grew up in a family of nine children with parents who struggled with both poverty and ill health. Determined to help families like his own, he gained entrance into medical school, first in India and then in England. After graduating as a heart specialist, he returned to Calcutta where he founded the first Indian hospital devoted to heart care and extended services to underprivileged children at no charge.

Dr. Devi Prasad Shetty

Once established in Calcutta, he returned to his native state of Karnataka where he founded an organization called Narayan Hrudayalaya, or NH, which stands for God’s compassionate Home, and there his real leadership began.

His first breakthrough came with a new method of heart surgery. Volume is the key to the NH practice of heart surgery, achieved by limiting the heart surgeon’s work to just those tasks that no other doctor has the training or skills to perform. All else is done by dedicated but less skilled professionals. This allows the heart surgeon to perform at least 5 surgeries per day instead of the standard, which is one. It means that NH spends 12 – 13% of its revenues on salaries instead of the normal 60% spent elsewhere in the country, while still maintaining the admirably low mortality rate of 1.5%, and a high staff retention rate because they are well paid for their skill levels, well treated and proud of their work. These percentages also allowed him to accept poor children with heart problems free of charge.

Dr. Shetty also focused on the fact that 70% of India’s population lives in villages but 70% of the country’s doctors lives in cities. He therefore persuaded the Indian Space Research Organization in Bangalore to provide satellite connections that allowed NH to establish a telemedicine network between city hospitals and villages. With help from local IT firms, NH built a technology infrastructure and used digitization to whittle down the cost of X-rays. The networks link rural coronary care units (CCU’s), which are staffed by general practitioners, with medical experts. Before these CCU’s were established, 50% of patients who died at district hospitals succumbed to their diseases or medical problems without any advice from a specialist. Now many thousands of patients are treated successfully via the network.

Dr. Shetty also saw the urgent need of health insurance for the working poor. To make insurance affordable, a very large number of members had to be enlisted, so he partnered with a dairy farmers’ cooperative to launch his program because it had a membership of 1.7 million farmers. All who had been members for at least one year were invited to join regardless of medical history, and the fee was five rupees, or eleven cents, per month. The system is cost effective because only a small percentage of members require care at any one time and because it also provides basic information on preventive measures.

Dr. Shetty is a perfect example of a skilled physician who had an abiding interest in his community, combined with inspired creativity and with an ability to study and analyze a situation with a deep understanding of its complexity.

Yet another example of creative leadership is more personal and has made a huge difference in my life as well as thousands of others. In the year 2000, after being told for several years that I had a tendency toward anemia, one doctor realized that the problem lay elsewhere, and after more extensive tests, found that I had a rare form of blood cancer called Waldenstrom’s Macroglobulinemia or WM. I was told that it was both fatal and incurable and that I had about 5 good years left. I conducted a thorough search of the world of hematological oncology through the internet and uncovered a doctor who was focusing on just this disease at the Dana Farber Cancer Institute in Boston.

Dr. Steve Treon is a caring hard working hematological oncologist who was feeling frustrated in his research on this form of cancer because there were so few of us patients in the US that he found it difficult to make progress in his efforts to find an effective response, much less a cure. We talked about the level of knowledge of WM in general, of my case in particular, and about the amazing benefits of the Fulbright Program and its ability to connect people around the world to examine all manner of issues. The tremendous benefit of these collaborations across borders is that the differing attitudes, outlooks and training broadens the research and often helps to break down and solve problems better. Dr. Treon saw the advantage of this approach, and I left feeling that I was getting the best possible medical attention. Within a few short weeks I started the regimen he suggested and with great success. In a few short months Dr. Treon sent me an announcement of the first international conference on WM, to be held in Boston, and I was invited to attend and speak.

Dr. Steven P. Treon

At this first meeting there were doctors from nine different foreign institutions and patients from around the country. There were the expected presentations of research in progress and unexpected interactions between patients and the attending physicians – conversations which were more leisurely and wide ranging than is possible in a hospital; it was clear that they were enlightening to both doctor and patient. There was also a pervasive enthusiasm about the potential for progress as a result of this collaborative effort, both between doctors from different countries and between doctors and patients.

Today, the outcomes of this international organization have exceeded everyone’s hopes and dreams. The cohesive community, which has really grown each year, built around this rare disease, has been able to conduct far more effective research than any one individual doctor or institute could perform because of the coordination and interaction, and the resulting knowledge of what causes WM and how to deal with it is growing exponentially. I am particularly pleased to report that they have among their number Fulbright scholars who are fulfilling their scholarship obligations as researchers at the Dana Farber Cancer Institute.

As of the beginning of 2006 there are 25 centers in Australia, Canada, the United States, Latin America, the Far East and throughout Europe, and Dr. Treon expects that number to double within the foreseeable future. The conferences’ ability to bring patients and doctors together has not only increased the understanding of the issues but has turned the patients into advocates of the work, thereby facilitating the fundraising necessary for continuing the research. The annual conferences are now held in a different country each year, and the doctors involved are sharing their findings in a collaborative manner and planning trials in consultation with each other to maximize the knowledge gained.

Steve Treon understood the power of collaboration. He knew that if he shared the results of his research freely, he could attract like-minded physicians around the world. The resulting knowledge about Waldenstrom’s Macroglobulinemia is expanding rapidly, and – who knows – there might even be a cure in sight soon.

As you can see, leadership is about listening and interacting with those around you, knowing how to use your skills and equipment for the benefit others. It is about conducting an examination of a problem, careful enough to understand the core of that problem, being willing to entertain unusual approaches and knowing how to arrive at a truly effective solution. It is a willingness to reach out and collaborate freely with others on a problem of common interest, no matter how daunting. It always takes hard work and perseverance

With these attributes a leader can engage the hearts and loyalty of a friend, a community, a nation, or any group so that all its members can together engage in meaningful work leading to satisfying improvements and accomplishments. Like Dr. Devi Prasad Setty and Dr. Steve Treon, we can all give real meaning to the words of Margaret Meade:

“Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that has.”

Harriet Mayor Fulbright is president and founder of the J. William and Harriet Fulbright Center, which works to create peace through education exchange programs around the world.