Last winter in Honduras a Peace Corps doctor was walking through the streets of a mountain village, population, perhaps 2,000. As I watched him, the scene developed just like the stories in the Bible. People came flocking out of their houses bringing the lame, the halt and the blind. A woman said, “Doctor, look at my baby:" An old man exhibited his leg. The doctor stopped occasionally to pat a child, comfort a mother. He knew practically everybody, and they knew him--and loved him.
Later, I mentioned this incident to my wife. She said, “That’s the way everything was right here in the United States, --before civilization!
Now that was quick reaction and maybe it sounds a little strange. But it’s true: That’s the way things were -- “before civilization,” -- before specialization, when the business of doctors was people, not parts of people!
I have several proposals to take us back to the humanity we had “before civilization,” and it seems most appropriate to make them here tonight, as we meet on the 100th Anniversary of Boston City Hospital. This life span divides equally -- 50 years before the revolution in American medicine caused by the famous Flexner Report on medical education, and 50 years following that report.
During the first 50 years of this hospital’s life, much of American medicine was in a poor way.
Medical schools were inadequate. Educational standards were almost non-existent. Quack practitioners were a dime a dozen. Scientific research was not being related to medicine.
Then in 1910 came the famous Flexner Report. As a result, 150 medical schools in America were pared down to 50! The semiquacks were sept out. Standards were jacked up. A college education became a prerequisite for medical school entrance. Science came in, in a big way!
As a result of this revolution, we have made incredible advances in medical science, raised life expectancies, slashed maternity mortality rates, and ended the threats of many diseases.
But it seems that at the same time we have lost, something of our human contacts. Doctors have had to specialize more and more. Their training has become more complicated and time-consuming.
It is like the ever-expanding universe: The doctors are spinning off into science, research and specialization faster than the patients can catch up to them: Doctors are staying in the big cities where all the best facilities are located for both training and practice. Many of these doctors have gotten so specialized, that an ear, nose and throat man thinks a stomach man is beneath him, and a brain surgeon is just above it all!
So part of our problem today seems to be to get these doctors talking to people again. So one of my proposals tonight, is, this:--Why not join the Peace Corps? Return to the grass roots medical practice, a doctor can achieve in the Peace Corps: We need doctors in the Peace Corps, not specialists -- except perhaps snakebite specialists. We need just plain country doctors -- in the literal sense, because a doctor in the Peace Corps often has to cover a whole country. He doesn’t need a “bedside manner.” What he need . is more like a roadside manner. Something like John King, a 26-year old Peace Corps staff doctor who graduated from Yale to paying “house calls” in Tanganyika -- 500 miles apart -- in a single day: John spent two years in Tanganyika for us, then signed on for an extra year in Somalia. He got to ‘like bouncing around in a jeep over dirt roads twelve hours a day '. Or at least he never complained about it. It’s true he did marry one of our nurses in Tanganyika. But there’s nothing wrong with that. Where else can a young man be sure that his prospective wife is mentally, physically, etc.
Franz Koning, one of our volunteer doctors in Sierra Leone, came to the Peace Corps from Seattle, Washington, where he was a general practitioner. It wouldn’t have helped him much to be a cardiologist. In a single day in the Magburaka Hospital Clinic in Sierra Leone he examined 150 men, women and children and these are some of the things he diagnosed:
25 cases of malaria, one case of TB, 3 tropical ulcers, 1 yaws, 8 cases of combined malaria and roundworm, 1 gonorrhea, 1 skinworm, 1 schistosomiasis, 3 snakebites. There were also five cases of multiple tropical disease, including anemia, beri-beri, pellagra, malaria, malnutrition, roundworms; one case of gonorrheal conjunctivitis-- four abscesses, one fracture, one burn.
Now that was on a Monday: A busy day at the clinic. It’s not like that the rest of the week. Tuesdays through Saturdays it’s just routine stuff, like elephantiasis, leprosy, polio, meningitis.
Just a few weeks ago, Dr. Bob Cooke, the distinguished head of pediatrics at Johns Hopkins, said in a speech dedicating a new children’s medical center that diseases like rickets and scurvy were rarities in America now, antiques. “Today,” Dr. Cooke said, “the presentation of a case ' of vitamin D deficiency rickets or scurvy, would be a ‘cause celebre,’ attended by a full quota of house staff and students!
Well, we put on this kind of “show” in the Peace Corps every day of the week -- and we’d be delighted to have “a full quota of house staff and students” attend, and stay awhile!
Franz Koning, along with five Peace Corps nurses and Dave Griffith, another volunteer doctor from the Yale Medical School, have given a tremendous boost to the Magburaka Hospital. Patients are coming there from all over Sierra Leone, walking, flying, or riding buses, one mother and father came there on foot from twenty miles away carrying an infant who was suffering from an abdominal hernia. The Peace Corps medical team is handling all this without any fancy medical equipment. When one of our Washington staff members visited them and asked if they needed anything, they said yes. And do you know what they needed? Not an electroencephalogram. Not a heart lung machine. Not a vacuum extractor. Nothing like that.
They said, “get us rags. We need rags to help keep things clean as we need them around here. There are no rags in this country.”
Then you go up the West African coast a little, and you come to Togo, a country that had only 10 doctors’. In Sokode, the upcountry capital in Togo about as big as Jamaica Plain, we have 20 volunteers, including doctors, nurses, lab technicians, and a pharmacist in a medical team that’s operating the Sokode Hospital almost alone; running public health programs in the area; running clinics in surrounding villages; teaching s hygiene in the schools; running a milk program; and so forth. This whole program was put together by Nick Cunningham, a pediatrician in his mid-thirties who came to us from the Indian Health Division of the Public Health Service. Nick personally set up the program, then recruited a surgeon, a generalist, another pediatrician, a pharmacist and 15 nurses -- from all over the country. Nick was a top student at Harvard, got his A.B. in.1950, before going on to a medical degree at Johns Hopkins.
What Nick Cunningham and other doctors have been finding out in the Peace Corps, is something almost forgotten in the medical profession in America. First of all they’ve been dealing with the individual as a whole -- not as a gall bladder or as a right ventricle. They’ve been working as a general practitioner, surgeon, diagnostician, and psychiatrist, all the same time. They’ve been getting away from the technology of medicine and back to the art of medicine – the art of dealing with people. And another thing -- they’ve been learning the challenge and fascination of preventive medicine that deals directly with human beings. In this country, preventive medicine has become so sophisticated that it deals most with things, pollution of streams, pollution of the air, community resources, radiation control. It has gotten away from the plain business of TB control, VD control, feeding programs, immunization. The chief attraction for medical students in America is curative medicine, because the teaching of preventive medicine has become dry and uninteresting.
But there is nothing dry or uninteresting about seeing 150 patients, all with dramatic symptoms, in a long day in an African Clinic -- exhausting, yes, but not uninteresting.
Many of our Peace Corps doctors are coming back with a renewed interest in “human” medicine, in general practice, in dealing with people in the old family doctor way. Many who never dreamed of it before, now want to go into public health, preventive medicine. These doctors are going to have an impact on medical practice in America, a limited impact. As a matter of fact when you see them at the end of their tour, you begin to wonder whether they aren’t going to have as much impact on our own communities back home as they had abroad. If they practice the same kind of medicine in Council Bluffs, Iowa, as they did in Dar Es Salaam, Tanganyika, America will have gained as much as these doctors have given abroad.—
But this impact could be vast if the medical profession were to join the Peace Corps in a partnership--a partnership that would provide a two year “residency” in a “school” of general practice” conducted by Peace Corps doctors in 46 countries around the globe. Their training would be not only in surgery, not only in obstetrics and pediatrics, but in compassion, in patience, in endurance, in resourcefulness. And there would be times when their only equipment would be their hands, their only anesthetic, a soothing voice. Their only specialty would be in empathy.
All of this is broadening, and humanizing, for a doctor, but he doesn’t necessarily have to go abroad to get this kind of experience -- to Sarawak, or Nepal, or Nyasaland. The same sort of opportunity, the same sort of challenge, the same sort of need still exists in some places in this country. And that’s what my second proposal is about.
We need doctors in the program to wipe out poverty in the United States. Despite the great progress made in the last 50 years, we have a tremendous job to do right here. It is a job of going out to the people, the 30 million poor people in this country. It is a job of taking medicine to the places almost deserted or never visited by doctors.
Life expectancy in this country has been raised dramatically but the non-white population still lives eight years less than the white population. The death rate for non-white infants is twice as high as for whites. Ninety-nine per cent of our white children are born in hospitals, but non-white children who enjoy this advantage are 13 percent lower.
Poverty is not strictly a problem of non-whites. Far from it. Nearly 80 percent of the poor are white: And it’s not strictly a problem of city slums. About 50% of the poor live on farms and in rural areas!
In the rural areas of Alabama, Mississippi, Arkansas, South Carolina and Georgia, 25 to 40 percent of the mothers give birth to their babies unattended by physicians. In Alaska 21 percent of non-white mothers bear their children without medical assistance.
That’s just a sampling of the remaining medical problems among the poor. President Johnson’s program against poverty will offer doctors and nurses a real chance for service to humanity, at its neediest, in our desperately poor rural areas, among our migratory workers, or on Indian reservations -- on all those frontiers still untouched by progress.
Eventually, the Government may be able to offer service in the war against poverty, as well as service for volunteer doctors in the Peace Corps, as an alternative to regular military service. But in the meanwhile the medical profession could give tremendous impetus to our efforts in two ways: -- Volunteer doctors in the Peace Corps could be given additional credit with their specialty boards for work done overseas. And young doctors could be permitted to take an official one year residency in some area of the anti-poverty program in the United States. This-would combine their academic training with a first-hand experience unavailable elsewhere.
My third proposal tonight has nothing to do directly with the Peace Corps or the poverty program. It has to do with American society, with the character of American life. The medical profession in this country has been getting more and more insulated from the rest of American life. Everything in it focuses on professionalism. Too many doctors talk only to other doctors, they go only to doctors meetings, doctors parties, doctors conventions. People outside the profession are seen only as patients. In this country we seldom see doctors in other fields. A study of the recent 85th Congress, showed that in the House of Representatives there were 234 lawyers, 49 businessmen, 23 educators, 23 journalists, 23 former state or local officials, 20 farmers, 16 real estate and insurance people, 7 former Congressional aides -- and only 5 doctors, and one dentist: The doctors were tied with the bankers and the advertising and public relations people...but at least they beat out the funeral directors!
In other countries it is a different story.
In Indonesia 40% of-the ministerial officials are doctors. Foreign Minister Subandrio is a doctor, and so the Minister for Private Banks and Capital.
In South Viet-Nam, the Minister for Foreign Affairs, the Vice Prime Minister, the Minister of State (and others) are doctors.
The President of Argentina, the Ex-President Kubitscek and the Secretary of Agriculture of Brazil, the Chilean Minister of the Interior, two Vice Presidents of Costa Rica are all doctors!
This is true in many other countries where education is generalized and not so heavily concentrated on the highly, scientific aspects of medicine.
Right here in this country doctors in public life would certainly have a different exposure to humanity. They would get new insights into the needs of all our people. Likewise doctors would be in a better position to advise our policy makers and appreciate their problems as we try to make a better society.
They might also give the public a new image of the medical profession and inspire a greater number of our young people to go into medicine.
In a nation that devotes five percent of its Gross National Product to health and medicine, how can medical people neglect to take a bigger part in public life, whether on a local, state or national level? In the Peace Corps we have some doctors serving overseas not as doctors but as full time administrators. Dr. Charles Houston, for instance. Dr. Houston was a magna cum laude graduate of Harvard, then magna cum laude again at the Columbia School of Physicians and Surgeons in 1935. During World War II he was a Navy flight surgeon. Just before he came into the Peace Corps in 1962 Dr. Houston was working on the latest of a series of interesting posts--as a cardiologist at the Aspen cline in Colorado. One of his hobbies--mountain climbing and exploring--had taken him to India and Pakistan a few years ago. That got him interested in the plight of impoverished people overseas, and that got him interested in the Peace Corps. So in 1962 he took his wife, Dorcas, a nurse, and his three children to India, where he’s been running a complex Peace Corps program of 250 Volunteers.
Here was a man who had over a quarter of a century of varied medical practice -- and still he knew there was another kind of experience he wanted -- another world outside the world of clinics, waiting rooms and operating theaters. No one ought to train and work -- live and die -- under on professional roof. Everyone, sometime, ought to see how the other half lives.-- A lot of the staff members who came to the Peace Corps were lawyers, newspapermen, educators, legislators. These were men seeking a meaningful interlude, in the normal routine of their lives. A new exposure. And above all they were men who wanted to work with people, not with things.
So tonight I’m offering you these three broad avenues back to people, back to the mainstream of society; avenues that lead away from the special and back to the general: the Peace Corps, the poverty program, and public life. Surely they are roads that run parallel to the roads to scientific progress and better medical education. Surely these are roads that can be traveled simultaneously.
As Albert Einstein said, “It is not enough that you should understand about applied science in order that your work may increase man’s blessings. Concern for man himself, and his fate, must always form the chief interest of all technical endeavors...”
