College of Medicine Alumni Magazine: Winter/Spring 2023 The Big Picture: Alumni Delivering Global Health Care

If anything has become clear in the past few years, it’s that the global community is truly interconnected. National borders are increasingly permeable. Outbreaks, conflicts and natural disasters don’t respect artificial boundaries. In this environment of interdependence, Drexel University College of Medicine alumni are seeing the big picture of global health care, determining how best to make an impact and acting on their knowledge.

By Kate McCorkle

College of Medicine alumni from numerous specialties work or volunteer across the world. The Alumni Magazine caught up with three: Robert Edward Black, MD, MPH, HU ’71, professor and director of the Institute for International Programs and former chair of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health; William N. Hait, MD, PhD, MCP ’78, Johnson & Johnson executive vice president, chief external innovation and medical safety officer, and interim head, Janssen R&D; and Ian B.K. Martin, MD, MBA, MCPHU ’00, eminent scholar, professor with tenure and system chairman, Department of Emergency Medicine, and professor of internal medicine at the Medical College of Wisconsin in Milwaukee; and emergency physician-in-chief in the Froedtert and Medical College of Wisconsin Health System.

Although these physicians hail from different predecessor institutions, practice in different fields and focus on different outcomes, two related themes emerge. There is a sensitivity to the ethics of delivering care as an outsider and, with that, a willingness to listen and partner with local individuals and programs. Also, there is the recognition that, in order to be responsive and deliver the most impactful long-term care, research is critical.

You can’t think of one without the other

After graduating from Hahnemann University in 1971, Robert Black (who’d already completed a residency in internal medicine) was pursuing a fellowship in infectious disease at the University of California Los Angeles when he decided to simultaneously attain a Master of Public Health degree. The combination of those courses “opened my eyes much more to epidemiology and global health,” he says. He had the opportunity to work in Bangladesh through the Centers for Disease Control, and that was where “the hooks sank in.” The work sparked a lifelong dedication to preventing child mortality.

The World Health Organization estimates that two-thirds of the 5 million child deaths in developing countries each year are caused by infectious diseases, such as pneumonia, diarrhea and malaria, and that undernutrition contributes to nearly half of child deaths. Black saw this connection while living and working in Bangladesh. “It was quite clear that infection and nutrition are so closely related,” he explains. “You can’t think of one without the other. The interaction between the two is quite important in regard to mortality.” His career has focused on reducing child deaths though epidemiologic research, and trials of vaccines, treatments, nutritional supplements and other interventions.

Black is perhaps most widely recognized for his research into the mineral zinc. After a two-year sojourn in Bangladesh, Black, then a faculty member at the University of Maryland School of Medicine, lived in Peru, again studying the causes of child mortality. Although a zinc deficiency in low-income children had been discovered decades earlier, Black conducted pioneering studies that linked a zinc deficiency to increased susceptibility to infection, particularly diarrhea.

“It was rewarding that there was a direct link between the research I did and the policy from U.N. agencies.”

Diarrhea is the second leading infectious cause of death in children worldwide and kills more than half a million children each year. Through randomized controlled trials in South America, Asia and Africa and other inquiries conducted over “a couple decades,” Black concluded that zinc could both prevent and treat diarrhea — thereby significantly reducing child mortality.

In 2004, these studies led to a joint recommendation from WHO and UNICEF that all children in low-income settings should receive zinc, in addition to fluids, as part of the treatment of diarrhea. “It was rewarding that there was a direct link between the research I did and the policy from U.N. agencies,” Black says.

For this body of research and his frontline interventions, Black was honored with two international awards: Thailand’s Prince Mahidol Public Health Award, which is bestowed by the King of Thailand, and the Canada Gairdner Global Health Award.

Additionally, for the past 20 years Black has led an effort sponsored by the Bill & Melinda Gates Foundation, “to estimate the causes of childhood death globally” and determine what interventions are most successful. These analytics become the statistics used by WHO to influence international health care policy.

Throughout his career — and around the world — Black strived for “very strong partnerships” with local institutions. “Our role is to support them and help them get the work done,” he says. As a testament to these “mutually beneficial” connections, Black says many in-country partners were able to continue their work despite the interruptions caused by COVID-19. “In addition to the research that I’m proud of, the institutional ability to build capacity is much longer-lasting in terms of helping countries address child health problems.”

A remarkable thing

William Hait was on vacation when a Johnson & Johnson colleague dropped by, mentioning the then-current Ebola outbreak in Sierra Leone.

“I think we can make an Ebola vaccine,” the colleague asserted. Hait, who at the time was heading research and development for the Janssen Pharmaceutical Companies of Johnson & Johnson, thought, “How do we make an Ebola vaccine?” Yet his team did just that. “Sure enough,” Hait says, “we launched the first Ebola vaccine a few years later. It was remarkable. These are the kind of things, with strong leadership, resources and great, talented people, you can do.”

As executive vice president and chief external innovation and medical safety officer at Johnson & Johnson, one of the largest pharmaceutical companies in the world, Hait is in a unique position to influence global heath at a macro level. During his tenure leading Janssen, his team launched about two dozen new medications, an exceptional accomplishment. “We developed many of the world’s leading medications for multiple myeloma, leukemia, prostate cancer and lung cancer — probably 10 or so of what they would call blockbusters,” Hait says.

“It’s a remarkable thing. When you are in a big company like this, and you get into these leadership positions, you really can make a global impact.”

For all that notable success, Hait is relatively new to pharmacology. A 1978 MD/PhD graduate of the Medical College of Pennsylvania (enrolling soon after it changed from Woman’s Medical College), Hait was an academic for 30 years. He was the chief of medical oncology at the Yale University School of Medicine, founding director of the Rutgers Cancer Institute of New Jersey, and professor of medicine and pharmacology, and associate dean for oncology programs at the University of Medicine and Dentistry of New Jersey. His main research interest was translational medicine.

“What I realized,” he explains, “was that if you really wanted to get something onto the market, it’s very difficult, if not impossible, from a university.” Transitioning from academia to industry “gave me the opportunity to go from discovery aspects to actually launch products for the world.”

His Janssen team did just that with bedaquiline. The first new medication in 40 years for treating tuberculosis, bedaquiline was developed and then made available to low- and middle-income countries. Hait describes visiting hospitals in South Africa where “everyone there had drug-resistant TB, including the staff, doctors and nurses. There was no good treatment for it.” Bedaquiline was introduced and, during his team’s next South African trip, “all those hospitals were closed,” thanks to the medication’s efficacy.

Johnson & Johnson also developed and donates the drug mebendazole, which is for deworming children with soil-transmitted helminths, mostly in sub-Saharan Africa. Hait says that children take one pill a year and they’re completely dewormed. “It’s a remarkable thing. When you are in a big company like this, and you get into these leadership positions, you really can make a global impact,” he relates. “It’s thrilling to be part of it. I wouldn’t have imagined in a million years, having been a dyed-in-the-wool academic, to have experienced this next stage of my life.”

Hait has enjoyed great success in academia, in the field of oncology and now in the pharmaceutical industry. He credits MCP for providing a strong foundation, “both in the medical school and for my PhD.” This realization came, he says, when he was selected as chief medical resident at Yale over his Ivy League classmates. He wondered, “Do I really deserve to be here with all these kids who graduated first in their class from Harvard and Yale?” But after being selected, he knew. “I’d gotten a tremendous education, and it was Woman’s, that became MCP, that became Drexel. I have a lot of gratitude for that education.”

The Christmas Tree Effect

Nearing the end of his college years at Duke University, Ian B.K. Martin wanted to take time off before applying to medical school. His family wasn’t keen on this idea. “They were afraid that a ‘gap year’ would turn into a ‘gap lifetime,’” Martin recalls. “I would lose momentum and never go to medical school.”

Fortunately, his family’s fears were not realized. Not only did Martin attend medical school, he went on to found and lead two global health training programs and he continues to mentor countless individuals in this space.

As an undergrad, Martin thought the Peace Corps might combine his interest in global health care with a pause in higher ed. Yet during a study abroad experience in Cameroon, he recognized that the Peace Corps wasn’t oriented toward health care. Instead, Martin spent his gap year teaching just outside Philadelphia, which eventually led to enrollment at MCP-Hahnemann University.

“One of the things that really drew me to [MCPHU] was its commitment to diversity before that was a thing,” he says. “They really put money into it. As an in-state, minority student, I paid half tuition. That’s an incredible enticement to get students of color to be part of such a distinguished school.”

“When you take care of one patient at a time, maybe you’ll touch a few thousand patients. If you engage in educational program development, you get the Christmas tree effect. So maybe you get tens of thousands,”

Dual-trained in emergency medicine and general internal medicine, Martin accepted his first faculty position at Duke. Yet there was still “this unmet thing I wanted to do, which was provide health care in a global setting.” Fortuitously, his emergency medicine division chief was also an expert in global health and emergency care. She mentored Martin and ultimately “bestowed her work” in Kenya and Tanzania to him.

“When I was young and starting out, I, like so many in global health, focused on direct clinical care in remote, resource-limited settings, which was fulfilling at first,” Martin explains. “Quickly I recognized that my impact was limited to the number of patients I could actually see and the time I would actually be there.”

This familiar trajectory for many physicians providing care abroad spurred Martin to become involved in educational program development, in short, creating what he calls the “Christmas tree effect.” “I teach two people who teach two people, and so on,” he says. “We help create some sustainability. Also, critically important to that — we teach locals. We partner with locals to build sustainability, capacity and agency in-country.”

Martin established the Duke International Emergency Medicine Fellowship (now the Duke Global Health Fellowship), a subspecialty training program designed to prepare fellows to lead in the global health and emergency care space. As part of the program, fellows engage in program development, conduct research, provide direct clinical care and build lasting partnerships. Fellows also complete course work leading to a Master of Public Health and receive intensive mentorship as early-career emergency medicine faculty members.

Drawing attention to the program’s sustainability, grounding in ethics and in-country presence, Martin points out, “You can count the number of fellows trained, but you can’t count the number of people they’ve trained that have made a difference in individual patient lives.” Martin also later founded and led a similar program, the Emergency Medicine Global Health and Leadership Program (GHLP) at the University of North Carolina at Chapel Hill School of Medicine.

He elaborates on the particular challenges faced by emergency medicine specialists working in sub-Saharan Africa. Along with trauma, they encounter the more typical communicable diseases, such as malaria and dysentery, yet non-communicable, chronic diseases like diabetes and coronary artery disease are also emerging. Coupled with this is the specialty’s relative newness in many parts of the world. Only recently has emergency medicine gained formal recognition as a specialty in parts of Africa — an effort Martin actively worked to support.

Martin reflects on the early days establishing the fellowship programs: “As we were going in and trying to elevate emergency care, we had to first understand the baseline. What were the diseases, the conditions, the capabilities, the capacities? These answers informed the next questions: What are the training needs? The staffing needs? What are the infrastructure needs?”

While creating this infrastructure has undoubtedly elevated emergency care locally, Martin highlights the next step. “When you take care of one patient at a time, maybe you’ll touch a few thousand patients. If you engage in educational program development, you get the Christmas tree effect. So maybe you get tens of thousands,” he says. “But if you ask important research questions and find some answers and disseminate that [knowledge], maybe you helped elevate emergency care for millions or billions of patients.” To that end, Martin co-chaired the 2013 Academic Emergency Medicine International Consensus Conference on Global Health, which generated a 10-year research agenda in global health and emergency care.

In their respective fields, Black and Hait have drawn similar conclusions. Hait, with his dual understanding of academics and industry, observes, “Knowledge is generated at the universities. Generally speaking, fundamental knowledge is not generated in a big pharmaceutical company. We generate a lot of knowledge about making medicines. Knowing diseases — that comes out of the universities.” So the research is critical — whether from a university or the frontline clinical trials Black uses to generate WHO data and policy.

“There are two ends of the spectrum,” Hait explains. “One is at the very early part, making discoveries that lead to medications and new treatments. The other end of the spectrum is delivering, through access. In many countries it’s difficult for people with health problems to access treatment, including our own.”

College of Medicine alumni are active throughout this spectrum: conducting research in the field and in the lab, asking questions in academia and in-country. Physicians are personally delivering care on a patient-by-patient basis as well as contributing to new drugs that will help entire populations.

When delivering global health care, ethical implications matter as well. Even if a physician remains in-country for an extended period of time, eventually they return to the U.S. This temporary nature of working overseas means it is imperative to help create and nurture sustainable health care. Black, who’s spent his career — minus time at the CDC — in academic institutions, says, “We have a very strong commitment to building capacity, to training, to health education and to building skills. I’ve had the good fortune to have had dozens and dozens of students who’ve graduated and gone on to work in their home countries. It’s satisfying to me that they’ve become experts. They’ve become leaders with their own countries and had accomplishments on their own.”

Martin unifies these themes, noting that the joys of a vocation in global health care outweigh the challenges. “No matter what the specialty — if [global health] is a passion, there’s a way to make a career out of it,” he says. “Focus on sustainability and your ethical lanes. Focus on partnership. It’s not, ‘We’re going to come in and tell you what to do,’ but, ‘We’re going to partner with you about the things that are important to you.’ It’s an incredibly rich way to spend one’s career.”