Back to school with Colombia’s top doctor

José Patiño, an old hand in Latin American medicine and education, has a new use for the Yale System.

By John Curtis

Although he believes that Colombia already has too many medical schools, José Félix Patiño, M.D. ’52, HS ’58, is leading a drive to create one more. He hopes the new school—a joint venture of the prestigious Universidad de Los Andes and the Fundación Santa Fe de Bogotá (FSFB), a medical center Patiño and others founded 20 years ago thanks to the philanthropic gift and dedication of Alfonso Esguerra, M.D. ’64, and his wife, Gloria—will raise the level of medical education in Colombia. Patiño’s model for the new school is the Yale System of medical education.

“The main thing that we are taking from the Yale System is the flexibility of the curriculum and the responsibility the student has in learning, and not only what the teacher provides the student. The students have to learn how to learn and be students for the rest of their lives,” Patiño said in January during a telephone interview from his home in Bogotá, Colombia’s capital. “When I was a medical student at Yale, my fourth year was practically ad-libbed. I could do whatever I wanted because I had completed all my subjects, and that gave me the opportunity to attend lectures and classes in other subjects all over the university.”

This new medical school, scheduled to open next year, will be the latest in a string of achievements in medicine, education and social welfare that Patiño has brought to his nation during a 45-year career. Since returning home after his education and training in surgery at Yale, Patiño has served Colombia as director of the Association of Medical Colleges, minister of health, rector of the National University and president of the National Academy of Medicine. He worked with John D. Rockefeller III and Robert S. McNamara to bring Rockefeller Foundation and World Bank grants to Colombia. In recent years he also found time to write a biography of the opera diva Maria Callas.

As minister of health in the mid-1960s, Patiño introduced generic drugs to Colombia, dramatically lowering the cost of medications. While rector of the National University, one of the country’s largest public colleges, Patiño restructured 34 distinct faculties, brought in full-time faculty and obtained funding for teachers and researchers.

Patiño has continued to indulge his passion for opera, acquired from his father, also a physician, who took his family to listen to operas at Bogotá’s Teatro Colón. While at Yale, Patiño traveled to New York to hear a new singer with a marvelous voice who, although well-known in Europe and Latin America, had yet to make her debut in the United States. That singer was Maria Callas. “I became interested in her life, always in search of perfection,” says Patiño. “I own every opera she recorded but three. She sang operas that had been in obscurity and brought them to light.” Two years ago Patiño’s biography of Callas, now in its second edition, was published by Editorial Kimpres of Bogotá. He is the author of 18 monographs, over 300 papers and eight books, including a major surgery textbook dedicated to his professor at Yale, the late Gustaf E. Lindskog, M.D. This fall he will deliver the Distinguished Lecture of the International Society of Surgery (of which he was president) at the annual Clinical Congress of the American College of Surgeons in Chicago.

Looking back on the heady days of the 1960s, when he hobnobbed with McNamara and Rockefeller and served on a delegation that welcomed President John F. Kennedy on a state visit to Colombia, Patiño laments a change in international lending practices. “At that time the World Bank had a different philosophy than it has today. Their philosophy was that of John F. Kennedy, to help the poor,” he says. “To see how the World Bank functions today, pushing globalization without considering the local situation, is traumatic.”

The Fundación’s vision of helping the poor has become reality in six low-income neighborhoods bordering its teaching hospital. The 180-bed hospital and medical center was the first in Latin America to have its own full-time staff of physicians. (Typically, Patiño says, hospitals in Latin America rely on the services of physicians who work part time while maintaining private practices.) Its mission includes the education and training of physicians, as well as providing medical care. Proceeds from the center’s clinical fees subsidize services for the poor that go beyond health and medicine. “The community health program is not only a health program,” Patiño says. “It not only relates to outpatient centers, but also to community development in terms of the environment and starting people on their own small industries. It has been a tremendously effective community program.”

Several members of the Yale medical faculty have traveled to Colombia to see the foundation and its programs firsthand. Among them are former Dean Gerard N. Burrow, M.D. ’58, HS ’66; former Deputy Dean Robert H. Gifford, M.D., HS ’67; Yale-New Haven Hospital President Joseph A. Zaccagnino, M.P.H. ’70; and former Chief of Staff John E. Fenn, M.D. ’61, HS ’66 (to whom Patiño refers as his brother).

The center also brought medical students from the United States to Colombia for training periods of two months to a year. During the 1990s, several came from Yale to a hospital in a small town outside Bogotá. Concerns over security put an end to that program, however.

Patiño’s desire to attack poverty comes from a long-held belief that it lies at the root of Colombia’s troubles. Two left-wing guerrilla groups who claim to speak for the downtrodden are at war with both the government and right-wing paramilitary groups. Both the paramilitaries and the guerrillas fund their activities through alliances with drug traffickers.

“The political system here is really complicated,” says Patiño. “The principal reason is the poverty, the extreme difference between the people of the higher socioeconomic class and the people in the lower level. There is a tremendous disparity and it is increasing instead of decreasing.”

Despite the prevailing image of Colombia as a country torn by warfare and strife, with large swaths of land under the control of guerrillas or paramilitaries, Patiño says Bogotá is a safe place. “If you come to Bogotá today you will find a normal city; entertainment, movies, restaurants,” he says. Also, he adds, Colombia is a marvelous country that has produced figures of the stature of Nobel laureate Gabriel García Márquez, painter Fernando Botero, rock artist Shakira and Formula One racer Juan Pablo Montoya.

He is optimistic that the country’s recently elected president, Alvaro Uribe, who campaigned on a slogan of a “firm hand” with insurgents, can improve the political situation. In the meantime, life goes on and he continues with his plans for the new medical school.

The new school, Patiño says, should be up and running by January 2004. Why would someone who believes there are too many medical schools want to add one more? In the 1970s, there were only eight in this country of 41 million people. Now there are 45, most of which were established in the past decade since the national government began to promote higher education by encouraging the opening of new universities. “Many of them are really of very poor quality,” Patiño says of these schools. “The great contribution we think we will make is to set higher standards in medical education and serve as a model for other medical schools in Colombia and Latin America.”

John Curtis is the associate editor of Yale Medicine.

Familiar Faces

In Lost in America, a Yale surgeon opens up memories of his father

Sherwin Nuland

The latest and most personal book by Sherwin B. Nuland, M.D. ’55, HS ’61, Lost in America: A Journey With My Father, grew first and foremost out of his need to dissect his tangled feelings of love and resentment toward his immigrant father. But Nuland’s memoir about his impoverished childhood in the Bronx also arose from his discomfort about how others view him today: those who have known Nuland as the urbane surgeon, scholar and internationally known writer have seen a public face whose polish reveals nothing of “the long road to get there.”

Nuland opens his book with an epigraph: “Be kind, for everyone you meet is fighting a great battle.” The book tells not only the story of his father’s tragedies but also the story of Nuland’s own “great battle”—his struggles with death, depression, anti-Semitism and shame.

“For many people who haven’t spent a lot of time with me,” says Nuland, a clinical professor of surgery at Yale, “I was some kind of a cool WASPy guy who comes from a very American background and has things all figured out. … But I’m also this other complex, confused person. The whole idea is that each of us is a bundle of inconsistencies.”

Some of Nuland’s confusion stems from growing up with a father who devoted himself to his wife and children but who raged against them, frustrated by his own failures and misfortunes. Nuland’s nagging awareness that he needed to examine his feelings about his father remained in “the back pocket” of his mind for several years after the 1994 publication of How We Die: Reflections on Life’s Final Chapter. The book was tremendously successful, winning the National Book Award and selling a half-million copies in the United States alone. But readers pointed out something that shocked Nuland: he had intimately described the illnesses of several family members without once mentioning his father.

“I didn’t understand why I’d left him out of the book,” says the 72-year-old Nuland in a late-winter interview in the office of his colonial house in Hamden, Conn. He realized, “I’m never going to really understand him until I write about him.”

Nuland begins his story not with an account of his father but with a scene from his own nightmarish year in a mental hospital when, at age 42, he was suffering from severe depression. The dispirited Nuland adopted the stooped posture and helplessness of his father, 15 years dead.

That father was an immigrant from Bessarabia, then claimed by Russia, who had come to America at 19, a garment worker who embarrassed his son by speaking mangled English and shuffling when he walked (a sign of a spinal cord disease that Nuland abruptly recognized one evening while reading his physiology text at Yale). Nuland’s father and adored mother had lost their first-born son before Sherwin, or “Shep,” was born. And then Nuland’s mother died, too, of rectal cancer, when he was 11.

Nuland was drawn to medicine both by his need to vanquish the disgust he felt about disease and because he revered doctors. “To me, as a child of 8, 9, 10, there was a nobility in a physician.” In his chaotic world, physicians “had about them an equanimity that I genuinely admired, that was based on the reality that they really could do things, really could lift people up from the depths of despair and give them hope.”

Indeed, a young physician effectively saved Nuland’s life during his midlife depression. Nuland narrowly escaped a lobotomy because resident Vittorio Ferrero, M.D., protested the orders of his superiors at The Institute of Living in Hartford, Conn. Nuland recovered after a string of electroshock treatments.

These days Nuland devotes all his time to writing and speaking. He’s planning a trip to Shanghai this summer for the wedding of his son from his first marriage, and he has two young grand-children by his older daughter, a NATO diplomat in Brussels. His two younger children, with actress and director Sarah Peter-son, are of college age.

Nuland says his books have allowed him to become a kind of family physician in print. In that sense, he calls Lost in America “my ultimate book.” “This is a kind of therapy for everybody who reads the book, to recognize that it’s OK to be complex and confused. ... Because essentially what I’m saying is ‘Look, look where I was, and look how I gradually came out of that to have made such a rewarding life.’ ”

—Cathy Shufro

A dinner guest inspires a mission to help former slaves

The night her husband brought a Sudanese guest home for dinner, Cynthia Hymes Bell, M.P.H. ’84, heard a story that inspired her to risk her life. The visitor that night in October 1999 was Francis Bok, a 19-year-old who told of being abducted during a militia raid on a Sudanese village marketplace when he was 7 and spending the rest of his childhood as a slave.

Bell’s husband, the Rev. Gerald E. Bell, had met Bok through his work as senior pastor at the Southern Baptist Church in Roxbury, Mass. “He was determined for me to hear Francis’ story,” recalls Bell. When Bok told of being captured, the Bells’ 6-year-old son, Noah, began to cry. “That’s not right,” he said. “How can people take people?”

People do take people in Sudan: 10,000 to 17,000 people are currently enslaved there, according to estimates by UNICEF UK, most of them caught in the animist south and taken to the Muslim north. Because he survived a decade of captivity (as an abused farmhand) and eventually escaped, Bok might even be counted as fortunate in the Sudanese context. Civil war lasting nearly 20 years has killed two million people and displaced twice that number in the nation of 37 million that lies south of Egypt.

The story that so upset Bell’s son had a profound resonance for Bell as an African-American whose ancestors were themselves enslaved. Her sense of connection led her to join a trip to Sudan co-sponsored by the Zurich-based human rights group Christian Solidarity International, and My Sister’s Keeper, a faith-based initiative based in Boston. In July 2002, Bell reports that she witnessed the “redemption” of about 1,200 people. For $33 per person, the group bought back slaves from Arab northerners who make their living as “retrievers.”

Bell’s task was to talk to the tribal chiefs to find out what would happen to returnees without homes. “Many of them had no place to go. Their villages have been bombed, husbands have been killed, their children are missing. Where is home?” Some of the people may have lost their homes in raids by militias protecting Sudan’s oil industry. Those militias have burned villages and killed and enslaved residents to clear the area along the pipeline into southern Sudan that brings in oil worth more than $1 million daily. Complicating the situation is that southern rebels are fighting the junta in power.

Bell was relieved to hear that the chiefs would accept the strangers into their communities. She then interviewed the women to help them develop ideas for supporting themselves. They asked for a gasoline-powered grinding mill for grain.

A few weeks before her arrival, the spot where Bell camped had been bombed, and she lay stark awake in her tent for three nights. “I questioned whether I would see my family again. … Prayer kept me from totally freaking out.” She believed she was in God’s hands.

Bell and three other Boston-area women who have visited Sudan are researching prices for a grinding mill and consulting with contacts in Sudan about the safest place to locate it. “We’re building relationships so we can go in and help, beyond the slavery issue,” says Bell. Bell and the others in Boston, members of “My Sister’s Keeper,” speak about Sudan at churches and receive donations there. The next step, says Bell, is to use her public health training to develop a plan to respond to the threat and the effects of HIV.

—Cathy Shufro

Ten lines a day, for 78 years

Albert Doty Spicer, M.D. ’37, D.M.D., was 13 when he wrote the first entry in his diary—and every day since, for 78 years, he’s written 10 lines a day that record changes in 20th-century life. Spicer’s diary served as the basis for a recently published history of his hometown of Westerly, R.I., that describes the mundane and the memorable, from playing mumble-the-peg to dancing in the streets on V-J Day in 1945.

Momentous Events in Westerly, Rhode Island includes historic photographs of the seaside town and Spicer’s recollections: he watched the total eclipse of the sun—and saw a German dirigible on the same day—in 1925, the year he began writing. (He’s never missed a day since, though he had to dictate his entries a few times following two strokes.) In 1927, when he was 15, he saw the Spirit of Saint Louis circle over Providence, R.I., and then glimpsed pilot Charles Lindbergh drive by in an open car. Spicer describes the hurricane of 1938, which washed away a swath of the resort towns of Weekapaug, Misquamicut and Watch Hill. “Where there had been hundreds of houses, the beach was wiped clean. …” Spicer also recalls after-school escapades, including skijoring, in which a trotting horse pulled people on skis behind it. Spicer writes about the night the Westerly Fire Station burned down in 1927. He describes his mother’s cumbersome bathing costume, including stockings and shoes worn while swimming. When two-piece bathing suits first appeared in the 1930s, he recalls seeing a man on the beach “reading” an upside-down newspaper.

Although Spicer planned to study dentistry from the outset, he attended medical school because his father advised that a foundation in medicine would help him. An internship at Pawtucket Memorial Hospital allows Spicer to boast, “I’m the only dentist who’s delivered 60 babies.” After earning his dental degree at Harvard, Spicer set up an office in the town where his father and grandfather had served as dentists before him. His son, Albert D. Spicer Jr., was in his final year of dental school when he was killed in a car accident in 1965. Spicer’s daughter, Judith Spicer Knutson, helped assemble the book.

Spicer said the biggest change he saw during his career was the evolution from corrective to preventive dental care. He experimented with using music as an alternative to anesthesia. Spicer said the technique worked for most patients but never caught on. Anesthesia with a needle seems simpler and quicker to most dentists, he says.

Spicer lives by the Atlantic on Weekapaug Point in Westerly. He gave up skiing six years ago, at age 85, and has sold his sailboat, but he and his wife, Marion, welcome invitations to crew. Spicer has simple advice about what we should all be doing for our teeth: “Hang onto them!”

—Cathy Shufro


			Originally published in Yale Medicine, Summer 2003. Copyright © 2003 Yale University School of Medicine. All rights reserved.