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Issue 12013

Corps Competencies from West to East

Sandra Bretting

Photos by Smiley Pool

Doctor trades San Francisco Bay for Horn of Africa

Dr. David Gordon, a California native and Peace Corps veteran, made a 9,000-mile commitment to practice medicine at the University of Gondar in Ethiopia, training local health care professionals in the essentials of neonatal and pediatric care.

Through the Global Health Corps, Dr. David Gordon worked as an attending physician in the neonatal intensive care unit in Gondar, Ethiopia, where successful births often coincided with heartbreaking losses due to untreated pre-existing issues and complications during delivery.

Not every baby is born breathing. Sometimes, it’s up to the physicians and nurses present at delivery to coax the baby to take his first gulps of air. When David Gordon, M.D., began his work at the University of Gondar Hospital in northwest Ethiopia, he was startled to learn that not all of the hospital staff knew this basic step.

As part of Texas Children’s Hospital Global Health Corps program, he was at the beginning of a two-year assignment as a teaching physician at the hospital, with his time divided between direct patient care and training local physicians and students.

“It was heartbreaking, because we lost so many babies when there was no need for that to happen,” Gordon said. “I helped develop a resuscitation course so staff would know how to care for these children — that the best way to resuscitate a newborn is to warm his back by rubbing him and tickling his feet.”

Many mothers arrived at the hospital with previously untreated conditions that led to complications in delivery. In the neonatal intensive care unit, where Gordon worked as an attending physician, the joy of successful births was leavened by the pain of loss. Sometimes, despite heroic efforts, it was a matter of good care received much too late.

“The ones that stand out in my mind are the ones who didn’t make it,” Gordon said. “It was one of the most heartbreaking rotations I’ve ever been a part of.”

Despite his team’s greatest efforts, about four babies died each week.

But Gordon began each day anew, he said, with the same hope and the same determination to change a life — or to save one. And when he wasn’t caring for patients, he was still working to improve their care. He developed training materials for emergency pediatrics, he helped to establish outreach programs, and he developed curricula designed to extend medical training beyond the term of his assignment in Gondar.

Driven to care

How did Gordon — a native of Walnut Creek, California — end up teaching the basics of neonatal medicine to physicians and nurses in the mountains of Ethiopia? His journey began with a single trip he took as a high school sophomore to a remote village in Ecuador. After spending six weeks building latrines for a community of 1,000 villagers, Gordon, then 16, returned to California.

“It sounded like such an adventure at the time,” Gordon said. “But I took home a lot more. I took home a lifelong desire to do what I could to alleviate poverty.”

Gordon ultimately enrolled at Dartmouth College to study international development and political economics. After graduation, he signed up for the Peace Corps and landed in the heavily Muslim nation of Turkmenistan, which borders Iran and the Caspian Sea. Like his time in Ecuador, Gordon’s experience in the Peace Corps was transformative.

“Unfortunately, a lot of the time it was people in Washington who made decisions for volunteers on the ground,” Gordon said. “I — a Western male — was supposed to teach conservative Muslim women how to breastfeed. Since that wasn’t going to happen, I put together a health education class for kindergartners instead.” In fact, whenever he had any free time at all, Gordon spent it with children, and he admired people who dedicated their time to improving children’s health and well-being. This lifelong interest ultimately led Gordon to enroll in medical school at the University of Vermont in 2003, specializing in pediatrics.

Returning overseas

As he completed his training, Gordon’s attention returned to international medicine. While he was completing his pediatric residency at the University of California at San Francisco, he decided to apply to the Baylor International Pediatric AIDS Initiative (BIPAI), parent organization of the Global Health Corps. Gordon had heard about BIPAI from another physician, who told him about the program that places doctors in one of 13 “centers of excellence” in Africa and eastern Europe.

With his heart set on joining the Global Health Corps for a full, two-year program, Gordon applied in late 2009. But it was not to be. By the time he submitted his application — well before deadline — the program was already full. Competition remains steep, and entrance into the program is not a given for even the best candidates. But in February 2010, a new opportunity arose when the program’s former administrator told Gordon about a new program starting in Ethiopia. It was a chance to train physicians in Africa, and it was what he’d wanted to do since his trip to Ecuador at 16.

Gordon successfully applied, and he arrived in Ethiopia in August 2010. For almost two years, he divided his time at the University of Gondar Hospital between physician education, clinical care and improving hospital systems.

Unrivaled experience

For physicians who join either the Corps or BIPAI, the comforts of Western civilization give way to basic furnishings, huge patient volumes, and a salary that is one-fourth what colleagues might earn in private practice. But the payoffs are as numerous as the trade-offs.

“You’re getting hands-on experience you wouldn’t get anywhere else,” Gordon said. “Plus, you’re living in a third-world country for literally only dollars a day. But the biggest reason people do it is because they absolutely love making a difference in these communities.”

The need is significant.

“We have a shortage of medical experts, because while our country is indeed producing doctors, they’re leaving to practice in the United States or England,” said Mehretie Kokeb, M.D., an assistant professor of pediatrics and child health at the University of Gondar. “And, unfortunately, the ones who do stay aren’t always very committed because we don’t have the resources to compensate them.”

These challenges, however, were the reason for Gordon’s participation. Despite the difficulties of his work there, he treasures the experience. “I’m sure my job in Ethiopia is the best job I’ll ever have,” Gordon said. “It was everything I’d ever dreamed about.”

The return

Gordon returned to the United States in May 2012. He joined the staff at San Francisco General Hospital and also began moonlighting with a medical service that provides care to underprivileged children living in the Bay Area and his hometown of Walnut Creek.

But on a recent night in a San Francisco restaurant, the earthy smell of onions and garlic transported Gordon back to the verdant hills of Ethiopia. He couldn’t stop talking about the people he had met and the children he had treated some 9,000 miles away.

“I can honestly say that I’ve never felt so stimulated and excited by my work as a physician as when I was in the Global Health Corps,” said Gordon. “Anyone who has ever worked in a third-world country comes away with the realization that the world is not supposed to work that way. Life is not supposed to be so hard for the people — and especially the children — who live there.”

His work as part of the Global Health Corps didn’t go unnoticed.

“Whenever I think of Dr. Gordon I could literally cry because he was so good for this program,” Kokeb said. “Most telling of all — his shoes were never clean when he was here in Gondar. He was working much too hard for that.”

About Texas Children’s Hospital Global Health Corps

The World Health Organization (WHO) estimates that 7.6 million children under age five died in 2010 around the globe. Many of the diseases they succumbed to are largely preventable — illnesses such as malaria, diarrhea, pneumonia and tuberculosis.

To combat this grim statistic, Texas Children’s Hospital launched the Global Health Corps in 2011. The Corps is part of the Baylor International Pediatric AIDS Initiative (BIPAI). While BIPAI debuted in 1996 to treat children with HIV/AIDS, the Corps addresses other illnesses that affect children in underdeveloped nations.

The doctors who serve with Texas Children’s Global Health Corps care for children and their families in Ethiopia, Malawi, Tanzania, Botswana and Swaziland, and they train local doctors and nurses in those countries. There are plans to expand the program to Asia and Latin America.

For more information about BIPAI and the Global Health Corps, visit bipai.org.