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#74 Susan Lewallen and Paul Courtright, Pioneers in Global Ophthalmology
Dr. Susan Lewallen and her husband Dr. Paul Courtright have devoted their careers to providing eye care to underserved communities in Africa. Listen to learn more about their inspiring work and unique life stories.
Kilimanjaro Centre for Community Ophthalmology
Welcome to the Superintendent's Hangout, where we discuss topics in education, charter schools, life in general, and not necessarily in that order. I'm your host, dr Sharetta. Come on in and hang out. In this episode I was privileged to sit down with Dr Susan Llewellyn and Dr Paul Courtright. Susan and Paul are the founders of the Kilimanjaro Center for Community Ophthalmology, are world-renowned experts in combating blindness, have published hundreds of articles. Susan and Paul tell the fascinating story of how they met, how they were married, where their travels took them and much, much more. I hope you enjoy this fascinating globetrotting conversation as much as I did. Good afternoon, susan and Paul. Thank you so much for coming in this afternoon to hang out for a little bit. You're most welcome. I thought we could start with both of your origin stories, whoever wants to go first, but where you come from, what your backstory is and what brings you to the present moment, and then we'll kind of riff off of that.
Speaker 2:Wow, well, I'm almost 70, so that could be a long story.
Speaker 1:We got all day, yeah, okay, yeah.
Speaker 2:So I grew up in Colorado, I'm an American and I actually went to university at Harvey Mudd, which is near it's, in Claremont just north of here and I was a physics and math major.
Speaker 2:That's what I wanted to do. At the last minute I said I really don't want to do this. I think I'll see if I can get into medical school. So I did and really really enjoyed medicine. I chose to do ophthalmology and have really medicine's a wonderful combination of both art and science.
Speaker 2:So when I finished medical school I went to New Zealand for a while. I was a house surgeon there, just thought it would be interesting to live somewhere else. And I traveled up through the South Pacific and you know I looked at it and I said you know, it'd be really interesting to practice medicine here sometime after I finished my ophthalmology training. So I did my ophthalmology training with the idea that I would work in developing countries or at least look for opportunities like that. So when I finished my residency training which I did in Colorado, and I did medical school in Colorado too, which I did in Colorado, and I did medical school in Colorado too I got a job in the Caribbean, in St Kitts, and I was the ophthalmologist there for a while and did some volunteer things in Nepal and various places. Then went back to UCSF to do some subspecialty training and there I met Paul. So that starts. You know the journey that we've taken together and that's kind of how I got there.
Speaker 3:Okay, and I'm Paul, and my story is a little bit different in that my father was a pilot, and so as a child age 10, 11, and 12, we lived in Iran and I did my secondary schooling in Taiwan, and so I basically grew up my formative years in other countries outside of America. I did come back to the US to go to university. I did come back to the US to go to university but, frankly, when university was over I said I want to go back overseas and I went into the Peace Corps and so I went to South Korea doing leprosy work and so I lived in a village of leprosy patients and did that for a year. I got well I won't call it sidetracked, but I ended up in the middle of an uprising in which hundreds of South Koreans were killed, and from that I had to kind of shift positions. The government was not happy with me the military government at the time government was not happy with me the military government at the time and so after that I then stayed in Korea.
Speaker 3:But what I did was I started getting involved with the eye needs, eye care needs of leprosy patients. So I did a project. I spent a year traveling around to all the leprosy villages in South Korea, examining all the patients in terms of determining what their eye care needs were, and then shunt them into various systems so they could get eye care. When I came back to the States after that, I then went to Johns Hopkins to do my master's and after that went to UC Berkeley to do my doctorate, and that was because I was interested in public health and epidemiology in particular, and of course my focus, because of the work I had in Korea, really did relate to international health, to biostatistics, to epidemiology and, obviously, eye care. And during my time doing my doctorate is when I met Susan and of course we then embarked together from there on.
Speaker 1:So I don't want to gloss over those nuggets that you both mentioned, and I'm sure there are a lot of fruitful stories that come out of that. I'm thinking about a village where a lot of people have leprosy. Just, I'm thinking in my mind, I have this image and I didn't even know that such a thing existed. Maybe it doesn't exist anymore, but at that time it did, and so clearly both of you had a wanderlust and a sense of curiosity, but then also a sense of service right Wanting to. You could have both taken a perhaps a more comfortable, traditional approach to careers in a comfortable setting in the United States. What do you think was the impetus for this kind of globetrotting? Looking outward right, it's not that common in the US to have to meet people who have really had their focus be overseas this consistently. I'm just very impressed and drawn to that concept.
Speaker 2:Yeah, see, I'm just really puzzled by that. Why wouldn't people go overseas and see other parts of the world if they had the opportunity? I just felt so lucky that I was able to finish medical school without any debt, because, believe it or not, when I went to medical school, the tuition every year was $2,500, not even $1,000. And so I was able to finish school without any debt, which is fantastic.
Speaker 1:I just had a minor heart attack because my daughter's doing her undergrad. I mean, it's unbelievable.
Speaker 2:But you know that was a state university, University of Colorado, and my father was an ophthalmologist. I should say that Okay. And I knew what private practice in America was and you know it's like how boring is that?
Speaker 1:Dealing with insurance companies.
Speaker 2:Yeah. Well, it wasn't so much then back, then right, so much like that. But I just this is what I can't understand why anybody wouldn't take an opportunity, if they had it, to go out and see different things in the world. So it was a no brainer for me when I finished my training that I was gonna look, look around, for I got to the Caribbean and that kind of started it and then, you know, from there, some more training in San Francisco and Paul and I actually met in a leprosy clinic in San Francisco.
Speaker 1:We were both working there, so that was our yeah, that's a good icebreaker for if you ever have to say where did you both meet at a leprosy clinic.
Speaker 3:Yeah, working in a leprosy clinic with eye disease in leprosy and see for me, because my parents had taken me overseas, I just figured that it was probably the most fascinating experience one could ever have. And when you're young you know, I started at age 10, you kind of look at the world with open eyes and you don't judge anything. It's just, you just accept it the way it is. And my high school years in Taiwan were fantastic because you're old enough that you can go and explore on your own. And you know, my friends and I we just hopped on trains and traveled the island and found it fascinating and studied Chinese, and it was just an incredible experience that I think that most young people would jump at if they had that opportunity. And this is where I do the plug for a group like Peace Corps is because not only do you go overseas and do some really interesting work, but you live as people live there, you understand how they live and it opens a world that you would have no idea about. You can't learn that from a book. It has to be experienced. Learn that from a book, it has to be experienced. And both of us felt very strongly that we wanted our children to understand that and have that experience themselves. So you know, we moved overseas about what?
Speaker 3:A year after we got married and we moved to Ethiopia. But unfortunately, ethiopia at that time was a disaster. It was during the Marxist era. This was 1989, 1990. We only ended up spending a year there because just nothing worked. It was really a very difficult, difficult environment, but we moved down, we got a job. Both of us got a job in Malawi, in Southern Africa, and and our, you know, our eldest son was born just before we moved to Malawi. So we had our eldest son and then, while we were there, we had our younger son. So it's also as a parent to be in a place where you can have child care, good quality child care. While both of us were working you know, susan was doing surgery and I'm the country director for the International Eye Foundation supervising projects around the country. I mean it was perfect. We got to do interesting work and at the same time, our family's right there and somebody else is changing the diapers.
Speaker 1:So that makes it rather nice, frankly. And then both your sons have grown up and, as I understand it from my research, they live in Africa. Yeah, that's home.
Speaker 2:Yeah, it is. It is One of them in Dakar in Senegal, west Africa, the other one in Nairobi in Kenya, in East Africa.
Speaker 3:It would be obviously more convenient if they lived closer together, since that's a huge distance from dakar to nairobi, but still, you know, yeah, that they have made their lives there and, um, they're doing fascinating work. Uh, nothing to do with public health or ophthalmology or medicine, but still it's really interesting work. So if we want to see him, we've got to buy plane tickets. That's just the way it is.
Speaker 1:I think I remember in doing some of my research that when you I think it was first you were first in Malawi, susan, I think you were the only eye surgeon in the whole country, or something.
Speaker 2:Maybe I'm exaggerating, not quite that dire, no.
Speaker 1:Yeah, but one of few, yeah, and you stated in an interview that you were actually not as busy as one would think. Right, you'd think you'd be completely overwhelmed. Can you talk about why that is and what cultural factors and other things were playing in?
Speaker 2:Thank you for asking that Because I have to tell you that most people don't understand that. Specifically, most doctors in America don't understand that. Because, you know, some of it has to do with just education, public education. A lot of it has to do, more of it really, with access to services. If somebody here in the US has an eye problem, they're going to get to an ophthalmologist. You know they're going to maybe go to their primary care person first, but then they're going to be and there's going to be an ophthalmologist, you know, within 10 miles or whatever, of where they are Sure. But that is simply not true in a lot of places in the world. And you know, patients don't understand, first of all when they start losing their vision when they get older, and that's when it happens, mostly because the main cause of blindness is cataract.
Speaker 2:And that's something that affects older people First of all. Some people just accept it and say, oh, this is part of aging. They don't know there's something that can be done about it. And then, if they do know there's something that can be done about it, or suspect there is, they don't know where to go. And then, if they do know there's something that can be done about it, or suspect there is, they don't know where to go. And then who's going to pay for them to get there? And maybe they've never been out of the village before.
Speaker 2:So they have no access to the kind of services so they're not lining up. You know, when an ophthalmologist has a clinic in a big city hospital, they're not lining up. People can't get in to see them because they need a bridge between the community and the hospital services. So that's why I wasn't that busy. I don't think we even understood that was 30 years ago how important that was, and we had kind of I imagined before I went to Africa that people would be lining up because surely there are all these blind people since there's no services. So wouldn't they be lining up? Well, no, they aren't, because they can't get there.
Speaker 2:And that is really why that was Malawi. Why, when we went back to Africa in 2001, right when we went to Tanzania, we decided the focus was going to be on setting up a Kilimanjaro Center for Community Ophthalmology. That we set up was going to be helping patients access services, rather than the focus on me going there doing the surgery. Because there actually were surgeons there but they didn't have any. They weren't busy either, as busy as they could be. They were really working below what they could be doing if they had patients, but there were no systems in place for the patients to get in.
Speaker 2:So that's what KCCO focused on. I can see Paul wants to say something. Yeah, I do.
Speaker 3:So I'm going to add a bit. One of the things we recognized in Malawi was that very few women were coming in. So if you looked at the numbers and because I'm an epidemiologist, I was looking at the numbers and who was coming in and using Susan's service, and she was the only one doing surgery for a population of about 5 million at that time. So that's a pretty large population and, as she said, you know, was not busy. But still she had statistics, you know, name, age, sex, where they're from, so I could actually map them out. And what was pretty striking was that there were twice as many men who were getting, you know, surgery as women. Now that didn't make any sense epidemiologically so. So then that really, you know, meant that we needed to go out to understand why weren't women coming in and utilizing the services and some of our the issues that susan just mentioned. It's just they're more problematic for women. The business of leaving the village, know that maybe that doesn't sound too challenging for people, but, you know, for an old woman who's never left the village, the idea of going to the big city is terrifying. So some of those are issues that are more prominent for women, but some of them actually are specific to women in that in many settings, many cultures, women have to ask permission to go and utilize the service from a husband, from sons, from brothers, and if that social support is not there, then she's not going to be able to access it. Then she's not going to be able to access it.
Speaker 3:I'll never forget a woman in Malawi that we were doing some radio broadcasts in order to encourage people to utilize the services and we got her to be one of our respondents on the radio broadcast and as she told her story it was really fascinating. She had been, her vision loss was getting worse and worse and worse and she was becoming more and more blind. But she couldn't come in because her husband would not provide the support that she needed to come in. Her husband died old age. You know nothing unusual about that. Within two weeks she was in the hospital because she said it's my choice, it's my decision. Now I don't have to ask somebody else.
Speaker 3:And unfortunately, I think that's too common way, too common to find that, unless you know, unless a man, the male member of the household, agrees, many women do not get access.
Speaker 3:And so we actually did quite a bit of research in Malawi and Tanzania and other countries to really understand all the details of that so that we could design programs to address it.
Speaker 3:And one of the things, for example, that we did is that whenever we worked with groups, not just in Tanzania but other countries, to organize an outreach where somebody would go out and examine people, we'd always have a counselor along, and that counselor was not so not to talk to the woman so much, but to talk to the male relatives, and so if they're the ones that had to be convinced you know, your mother, your wife needs surgery. It's only going to take, you know, one day. You know she'll be in, she'll be out, she'll be able to cook for you next week. You know all of this. And if they could be convinced, then the woman would get access. So we did see a big change, you know, in the ratio of men to women in many of the programs that we worked on. So it was successful. It's not perfect, not by any stretch, but it was quite successful in getting the numbers of women in and getting access.
Speaker 1:And did you face? I'd imagine you faced some cultural trust challenges as well. I mean, you're foreign physicians.
Speaker 2:Well, it wasn't Paul and Paul, and Paul and I did not go out doing this, we trained local people. Oh yeah, it would be totally inappropriate for us to be out there doing that.
Speaker 2:For starters, we only speak English. So that was a big part of what our center did was train local people, health care providers sometimes they were teachers in how to set up programs to go out and do this and counsel people and making doctors aware of why people weren't lining up, you know. So that's what our center did. It was a lot of education. It's capacity building.
Speaker 3:So you know, ophthalmologists come out of a training program and they have good technical skills but they often have zero management skills, maybe zero leadership skills, you know, zero understanding of what public health is, because that's not part of their training. Take people from where they're at and then say, okay, let's go through what do you know and then build people up from there so that they can run their own programs. And we're not. You know we don't run their program, they run their own programs. But we help train and our staff now do the training since you know we're retired from all of that.
Speaker 2:But you know what you're saying, paul, about having to teach doctors about this. I had to learn this. I didn't learn anything about public health in medical school.
Speaker 2:I didn't know anything about this, but because Paul comes from a completely different background, which was education first and then public health, I mean he had to convince me that there were patients out there. They just had these various obstacles to getting in. He had to convince me that there were really women were not getting services at the same rate as men, because all I knew was that I was operating and I was operating about as many women as men. But he said, yeah, but there's more women because they're older and you should be operating more. So that kind of very different approach to this has really been part of why it's been so much fun.
Speaker 1:You're a perfect complement to each other in that right yeah usually, I mean once in a while.
Speaker 3:We might disagree from time to time.
Speaker 1:I can't imagine that in a marriage. But yeah, it's interesting, right, you bring the technical side and the analytical, but also cultural side together. Right, and to make a real, yeah and and personal personality.
Speaker 3:Wise, we are different. I'm I'm more of a big picture person, you know, and susan's the more detail oriented.
Speaker 3:Yes, so you know, it's just that we approach things differently and I think that's what's also interesting is is you know I'll have this big picture and Susan will go what? How do you expect that to work? And you know she'll pick it apart, and then I'll expand it all again and she'll pick it apart. But you know that makes it so that we bring together, you know, those different skills and capacities to come up with an answer.
Speaker 1:So describe for us a little bit about how the work grew. So we went from a time of 5 million people and kind of not really folks, especially women, accessing services at the level they should or could have, to where the work, the capacity building had gotten to at the point that you decided to both retire. Like what's that look like?
Speaker 2:Okay, well, after those four years in Malawi, we actually came back to the United States for seven years, and I was in private practice during that time in Bellingham. Washington and Paul was on the faculty at University of British Columbia. We lived near the border.
Speaker 1:Beautiful country up there. Huh University of British.
Speaker 2:Columbia. You know we live near the border, beautiful country up there, huh yeah. So. But all the time we were there, our plan was always we're going back to Africa. We're going to find a way and, using what we learned in Malawi about, you know, these problems of access and the gender disparities and all that kind of stuff we're going to go back to Africa and we're going to set up a center that's going to be devoted to public health ophthalmology. We're not going back to set up a clinic to operate.
Speaker 2:We're going to set up a center because there was nothing like that on the continent. There was literally nothing like that on the continent. And so we have to think about this over the seven years that we were in Bellingham and you know how are we going to fund this when would we want to be located? Lots of those issues. We both liked East Africa. I think I was afraid of West Africa. Actually we're not francophones, so we wanted to be in East Africa. We wanted to be at a place where there was a medical school and, more importantly, a residency training program training ophthalmologists, so that we could, you know, have that be, be working with those people and a school for our kids and there had to be a school for the kids I was going to ask you about the school, so and this, and so moshi tanzania looked
Speaker 2:like the best place we could go. We also had a few contacts there and I mean, you know, we had some problems. People promised they'd support this and then pulled out and blah, blah, blah, you know. But gradually we figured out how we could do this by writing grants and getting certain non-governmental organizations to support us, and we had some wonderful support from the International Eye Foundation and SAVA Foundation, sava Canada, various groups you know that do eye work, agreed to help support us. So at least for a year or two. Well, we kind of felt it out. So we were supposed to leave in 2001. And I think it was. The date was like October and here came 9-11. We'd already sold the house, our stuff was packed up, we'd quit the jobs.
Speaker 2:We'd quit our jobs, although we probably could have gone back, but anyway, so it was. It was a bit scary, we. We left, though, in October. We were delayed a couple of weeks because of 9-11.
Speaker 1:Flights and stuff.
Speaker 2:And you know, went and started in Moshi, Tanzania, and started out in a storeroom that the hospital in this place had said yeah, you can do this, you can run your program. Don't ask us for much. We're not giving you anything. You've got to get your own funding, but here you can work in the storeroom.
Speaker 3:Built it up from there.
Speaker 2:That's where it started.
Speaker 3:So everything that we don't have any beneficiary out there that just gives us money every year. That would be nice but that's just not the reality. So we always have to write our own grants. And so we ended up writing grants that kind of fell into three different areas. One is research grants, and what I mean by research is not lab tests or anything. Research is really epidemiologic in origin, or understanding, you know, how we provide services, how we find children who have congenital cataract, for example, and diseases like trachoma. So they were.
Speaker 3:It was research focused on providing solutions to problems that are on the ground. So that was one set of grants that we would write. And the second are what I call training grants, and so we set up various training programs and we had the benefit of working with a wonderful eye hospital in India called Aravind and we sent our people to them and they came over. They have just they're an incredible institution. And so we set up, based upon all that work, we set up some training programs on management, on how to organize outreach, on instrument maintenance. You know whole, you know wide range of areas. And then the third area that we wrote grants are what I just call call programs, so that we would say a donor says you know, we want you to to provide cataract services for a particular area and so so we'd say, fine, we'd work with the ophthalmologist and whoever else was there, train them up, provide them financial support so they could do outreach and things like that.
Speaker 3:So all that work was all project driven. So frankly it's exhausting to be grant driven, but that's the way it is. And we did that for 16, 20 years and of course we've retired and handed that work over and the institution Kilimanjaro Center for Community Ophthalmology is still going strong. So our concern was, of course, you know, founders, when founders leave an institution, how well does it survive? How well does it survive? How well does it grow? How does it change? And it's been what six years, eight years.
Speaker 3:Eight years since we've handed over responsibility. We're on the board, of course, so we have some, you know, some provide some support, but the organization's still going, still going strong, doing the things that we worked on all those years ago. And how?
Speaker 1:how often do you go back to visit in person?
Speaker 2:Well, paul goes more than I do, because I frankly find the trip more and more grueling.
Speaker 1:That's a long one, huh.
Speaker 2:It's a tough one, it sure is, but you know well yeah.
Speaker 3:I mean I still do consulting. So yeah, so I usually do maybe three trips a year back to Africa and different capacities. So yeah, so I go back from time to time but really is just as a consultant to you know, do a training program or help plan different activities.
Speaker 1:So you know I, you've both had such a and well, at least from the from the traditional American perspective an adventurous kind of a lifestyle. I'm sure you've run into a lot of obstacles along the way you talk about when you said I could see it in your eyes. When you said how exhausting it is to live by grants. Right, you're probably on a very short one or two or three year cycle of funding and then you have to fund more money and I could only imagine the obstacles, the challenges you faced, money and and I could only imagine the obstacles, the challenges you faced what do you wish you knew? What do you know now that you wish you knew when you were starry-eyed, with fresh, freshly minted degrees and dreams of of making a big change in the world?
Speaker 2:wow, that's a tough one, because I'm afraid if I'd known how hard it was going to be, I might have been daunted and not done it.
Speaker 3:Yeah, I would say we needed a third party here, frankly, because the fundraising to keep something like this going is the big challenge, and you know we're trying to do the research, the training, the you know the programs and then, at the same time, trying to fundraise and to talk to donors. I would like to have a third person along who could do all of that. That would have made our lives easier. And now, how would that work?
Speaker 3:Frankly, I'm not sure, because to me, you only can effectively fundraise if you know exactly what's needed. You're on the ground, you understand it well. Um, we have some donors uh, for example, save a canada in vancouver have been wonderful to work with because they have gone out of their way to really understand what the issues are. You, you know on the ground, so that when we make a request, they understand the request and have been able to respond to that request, and that's quite a pleasure, as opposed to a donor saying we want you to do A, b, c and D and that may not actually be what's needed on the ground and that may not be something that can be done within that time period or for whatever reason. So we're always grateful when we have a donor that really understands, and if we had somebody out there fundraising for us that really understood, that would have made our lives a lot easier.
Speaker 1:So was the clinic kind of a nonprofit in the traditional sense that folks can donate.
Speaker 2:Yeah, the organization Kilimanjaro Center for Community. Ophthalmology is a 501c3. We'll put that in the show notes, yeah, so actually it has two separate organizations.
Speaker 3:The organization is here in the US for people that want to donate in the US, but we also have it set up as its own unit in Tanzania, and that's so that within the Tanzanian government system it's recognized as a Tanzanian institution. So yeah, so that's kind of the structure of how we work it.
Speaker 1:I'm just curious, were there other work it? I'm just curious, were there other other than cataracts, which, as you described, susan, isn't largely an age related kind of trajectory? Were there other illnesses that you faced in Africa that you might not have faced in the US? In your practice just of the eye.
Speaker 2:Well, yes, blindness, and yeah, the pediatric in the US in your practice Just of the eye blindness and the pediatric.
Speaker 2:Well, yeah, well, a couple things, and this is not public health stuff. But when I was in Malawi I was really lucky to know there's a wonderful malaria research institute. One of the top malaria research institutes in the world is in Malawi, and one night I was having dinner with the woman who directs at Terry Taylor and I said why do children die from malaria? You know what's going on. She said nobody understands the pathophysiology. I said how can that be? It's killing a million children.
Speaker 2:Nobody understands it. Nope, They've. You know, money hasn't been put into researching this. And I said could I look in their eyes and see what's in there? Because it kills people when something happens in the brain. Right, I said these two are connected, Right? She said, yeah, you probably won't see much. Well, I looked in there and I saw a different world and it was fantastic. This was my little thing that I've worked on for the last 30 years, because I was able, by being in that position, to describe novel findings that had never been recognized in the eye of children with cerebral malaria. Furthermore, they were predictive of outcome, whether the child was going to die or not. So it was a fantastically interesting and I still get goosebumps thinking about it. It was. I mean, I would never have had an opportunity like that in the US, and so, yeah, there's that. But, to be honest, that has nothing to do with blindness, but it does have to do with life and death, Life and death right.
Speaker 3:But we also had interesting experiences with pediatric ophthalmology. That is, you know, quite children in is that we asked them and we had a medical anthropologist with us at the time and to understand what was their story. When did they first recognize there was something wrong with their child's vision? Where did they go? What did they do before there was something wrong with their child's vision? Where did they go? What did they do before they got to the hospital? And we recognize that there was a huge delay between when the parent recognized there was a problem and by the time they got to the hospital. And what I mean by huge were many years, and for children you need to do surgery immediately. And so what was happening is these kids were getting so delayed that even though you could get surgery, you could improve their vision, but you could not restore it as well as if you got them early on. So based upon that, then we set up programs to go out and we called them key informants, and so it would be a woman in a we'd choose one woman in every village and they would identify any child who had problems with vision, no matter how young, even babies, and so we got them into the system so that we reduced the delay hugely. And this program that we started in Tanzania, then we helped spread it throughout gosh, throughout the rest of Eastern Africa. So we set up programs in Burundi and Uganda and Madagascar, malawi, a number of countries, and so that has really made a huge impact on getting children in as early as possible, getting that surgery and then providing the rehab that they need afterwards.
Speaker 3:And, as you might imagine, we also found, because we did a little bit of research, that girls were coming in later than boys. When we learned that we had to revise and change. So it's kind of like the research was driving our understanding and our understanding improved and then we had to do a bit more in order to make it better. So it was a constant process of of learning and then taking what we learned and then applying it in the field it's kind of the action research right exactly, yeah, as you go.
Speaker 1:Yeah, I'm intrigued by the malaria. I think how would a lay person like myself understand what you saw? Um well if that's possible to describe well, I guess I can't the blood vessels in the retina which you're familiar maybe you've seen pictures
Speaker 2:of that were full of dehemoglobinized red cells, so they didn't look red anymore, they were white. They were like ghost vessels all over the retina.
Speaker 3:Wow.
Speaker 2:Which is just astonishing. I thought I was seeing things.
Speaker 1:And you thought you weren't going to see anything because they were telling you yeah, you won't.
Speaker 2:Yeah, because they said there's nothing in it. Well, they didn't have the right instruments to look and they didn't know how to examine the eye. Basically, there are also hemorrhages, which had been described, and patches of whitening which were places where blood was not perfusing the retina, and all this is because of the parasites in the red blood cells that block things up.
Speaker 1:And you could predict somewhat from that whether the child would survive or not.
Speaker 2:Yeah, which really got their attention. Because when I was in there by myself at night looking at the eyes going, oh my gosh, I can't believe this. It's amazing. They couldn't see it because I was using a particular instrument that they didn't know how to use. But when we got and this was thanks to Paul I'd come home at night and go I can't believe it, I'm seeing things in there, I don't know what they are. And Paul says would you just make a form and start keeping track of it, and let me go to sleep. And so I did make a form and kept track of it and at the end of the first season we were able to show oh my God, the kids who have these findings are the ones who are dying.
Speaker 1:Good cross reference.
Speaker 2:And that got the attention of the malaria doctors.
Speaker 1:Has that been amplified now?
Speaker 2:that approach, oh yes, it's now a really important thing to have in any research.
Speaker 3:Part of diagnostic Part of the diagnosis.
Speaker 2:But, it was a fight to get it recognized. It was a fight because I had no camera to take pictures of this.
Speaker 1:Pre-iPhone, pre-everything.
Speaker 2:Pre-digital photography. And you know, I tried to write papers and submit them to reputable journals. And who's she? You know some. Yeah, I mean it was a real fight to get it, but we did. Eventually we got it out there.
Speaker 1:How gratifying though in the long run, right oh yes, a million times. Right.
Speaker 2:So interesting and I think it's been helpful in elucidating the pathophysiology of the disease. Wow.
Speaker 1:I never knew that about Malaria. It was really fun.
Speaker 2:Really really a fun thing to be involved in for all those years. Yeah, but I was lucky, because I couldn't have done that if there hadn't been this world-class Blantyre Malaria Research Project, which is run by an American woman that happened to be there and it was a small community, so I was able to get involved in it.
Speaker 1:What advice would both of you give? Uh, young people, you know, obviously here we work with um kindergarten through eighth and twelfth grade, but young people college age who are considering um going into careers similar to to to yours, I, you didn't chart a real predictable path, either of you, and I think that's the beauty of this conversation. So to me that speaks of real qualities, of curiosity and grit and resilience. What kind of advice would you give to young people just setting out on their career journeys?
Speaker 3:I guess there's two pieces of advice. The first would be to consider a group like Peace Corps, because what it does is it gives you work experience. It gives you an understanding of is this something that you really want to do? Because, let's face it, all of us can be sitting here in America and think I want to go and live in that environment and do that work and being there on the ground, you may think differently. So Peace Corps gives you a great experience to learn from it.
Speaker 3:You gain skills, and Peace Corps, what it also does is graduate school medical schools. They look very positively on a Peace Corps experience because what it says is that you've spent two years or more in another country in another culture, and that you've got the grit and stamina and you've learned a new language that's going to make you as somebody that's going to be attractive to that school. The other thing I would say is that, sitting in America, it's really hard to find the kind of you know, starting jobs that you could work on. However, if you're in, you know some. I'll use our youngest son as an example. So he after he, he actually did Peace Corps as well. I think our kids got brainwashed so they both did Peace Corps.
Speaker 1:Full disclosure. You're not a paid representative of the Peace Corps.
Speaker 3:Yeah, I wish they would, but anyways, no. So, anyway. So he went to Uganda and he wasn't quite sure what to do, but because he was there, he happened to see that there was a course being offered at Makerere University on solar power and solar how to install solar systems. So he took that course and he met an Eritrean who has set up a company of providing solar systems for companies in different countries, and they hired you know, you know, our son at probably peanut butter and jelly sandwich wages, but you know, it really gave him an entree into that world and so, yeah, he didn't make much money for a couple of years, but he got a great experience, and that experience then led him to go on to graduate school here in the US and now he's back in East Africa, now in Kenya, doing work on another part of sustainable energy that has to do with transport and electrification of what they call motorcycle taxis, boda bodas throughout all of Eastern Africa.
Speaker 3:So it's just an example of by being in a setting, you can find opportunities that you're not going to be aware of sitting here in San Diego. That's just the reality of it all. But I just think that people have to take a risk, and the fact is, both of us are probably more on the risk taker end of the spectrum than others. So be it. So that's kind of how we jumped into it.
Speaker 1:Susan, what kind of advice would you give to young folks?
Speaker 2:I guess what I'd really like to see is for people to think about their values and what matters. What matters in their lives, is it stuff? Is it having consumables? I'm a real anti-consumer, so I've got to not get on a soapbox here. But you know, do you really want to do work you don't really like so you can make money to buy stuff you don't need or care about in the end? Or do you want to do something interesting and put your effort into human relationships? And I would love it if young people thought more about that. Our whole society is so geared toward pushing consumerism and you've got to have this and you've got to buy that, and no, you don't. I mean, we learned, so it was easy to see, that all these things that people think they need are not what make people happy, and we learned how much we could do without living in these places, and really you can do without most of it. So that's, I'd like to see kids think about that more. What do they really need?
Speaker 1:As opposed to what does?
Speaker 2:the system tell them that they want, Exactly exactly.
Speaker 1:One of my dearest friends from college. We kind of took parallel career paths but he did his all in international education, so I don't know how many countries he's worked in. And he came to visit me a couple of years ago and he shows up with a backpack just a backpack, got off the plane and he was coming from Zanzibar via New York and then here. And I asked him like where are you going after this? And he goes I'm going to take a job in Qatar. And I'm like but where's your stuff? And he goes this is my stuff. And I'm thinking I just moved into another house and I'm like and I've been in the house for six months and my garage is already full and I'm thinking about getting a storage facility.
Speaker 1:And I thought it was such a contrast for me to talk to this guy and I don't know we were talking about home buying. And he said you know what's funny? I don't even know if I have a credit rating. And I thought what do you mean? You don't have. He said I've never had to borrow any money in the United States.
Speaker 1:So, contrary to what you think, david, the whole world doesn't revolve around Experian credit ratings in the US, so it's just an interesting paradigm shift to look at things through a different lens, from a different angle. That's what really intrigued me in reading about the work you've done and just the different approach you've taken to life. It's really kind of living vicariously, but I could imagine that there's also a lot of romanticizing that happens when you tell people oh, you know, we worked in Africa. We, you know all these years 20, 30 years worked in Africa. We, you know all these years 20, 30 years. What are some things that people don't know about living and working abroad that were like real kind of maybe I don't know about harsh realities, but just realities for you that you had to kind of face, and I mean part of it was Paul. Paul, you grew up already overseas, so maybe it wasn't the same.
Speaker 3:Well, I mean there are some physical hardships. Without a doubt, Electricity was not as reliable as one would want, and we had to end up getting a generator when it would go out for 24 hours, you know, three days a week. So yeah, that's a pain, and the same with water, and the Internet was always a struggle. The roads are difficult to you know, to get around in.
Speaker 3:And when I say they're difficult, it's that, frankly, they scare the hell out of me because people, the way people drive, and you've got so many potholes. I was always fearful for our kids and others when you know they're out working and we have had accidents. In fact, what was about two weeks after we arrived in in malawi, I was coming down like sorry, I was coming back up to blantyre from the lower sherry valley and this car coming coming down the hill lost control and slammed into the front of me and totaled my vehicle. Things like that happen and it's because of vehicles and people and potholes and all of that and so that is always a bit it's
Speaker 3:a bit of a challenge. So those are the physical things. I didn't really find the. The relationships you develop with people are always wonderful I won't say always. Some of them are challenging Are mostly wonderful. We definitely had some people that created more difficulty than we wanted. But when I think of the people that Susan and I have worked with over those years, but when I think of the people that Susan and I have worked with over those years who first came in, they had just either were just becoming ophthalmologists or who had just became ophthalmologists and we mentored them for a number of years. And those folks they're in places like Rwanda and Burundi and Benin and Madagascar and those folks are doing great now and they're really, they're charging ahead and they're really wonderful people to work with. And when I say I go back to Africa a few times a year, part of it's because I want to see, you know, our friends, our colleagues, because I miss them, because they're they're just a super pleasure to be around, and so that's that makes that makes the difficult people much more easy to tolerate and the world has gotten smaller in some ways right with
Speaker 1:with technology at least you can facetime your kids?
Speaker 2:absolutely yes, when we lived in malawi, we fax had just come along and we thought, wow, this is really cool. We fax had just come along and we thought, wow, this is really cool, we can fax, that is, if the phone line's working.
Speaker 1:Yeah.
Speaker 2:But now you know I can pick up the phone and what's at my kids anytime. It's just a world of difference.
Speaker 1:In the early 90s I lived in Central America and I remember in Guatemala. I remember to make a phone call you still had to go to the national phone company. They had offices. You'd go in and you'd say could you dial this number for me? You'd write it down on a piece of paper. They would go into a booth. They would call your name.
Speaker 1:You'd run in because the clock is ticking. I'm sure you guys had those kind of experiences and then, in subsequent visits that have gone back, now everyone has an iPhone. Yeah, exactly you know what I'm like. They leapfrogged over the whole landline suffering to cell phones.
Speaker 3:Yeah, no, exactly, it has made a huge difference, huge difference. And, like you, I had an experience like that when I was in Korea, where you have to rush into this booth and it was a summer day and the sun was blasting in, and within five minutes I'm just drenched in sweat and trying to yell you know to my parents on the other end of the line I'm still alive.
Speaker 1:Yeah, yeah, oh, man. So yeah, those days, those days are over. Yeah, how was it with family connections? Uh, while you were overseas, so for such a long time? You know, sibling, parent, whatever those?
Speaker 2:we were we. We came back once a year okay and we kind of built that into our plans. We were going to do that. We wanted the boys to know their cousins, um, their grandmother and grandfather and, and so we did that and and it was great and in fact we just got back three days ago from a trip to Denver where both of our sons came for my mother's 98th birthday With the elder now has is married and has a child and they're cousins and you know we all got together and it was really really great.
Speaker 2:Both of my nieces two of them actually came and lived with us for a year while we were in Tanzania and those things helped cement relationships.
Speaker 1:So I know you've researched and published a lot, each of you and collectively, and I understand, susan, that you're also writing some fiction.
Speaker 2:I've written two books of fiction.
Speaker 1:Tell us about that.
Speaker 2:Well, which part of it? I have always been a reader. And in fact, sometimes, when we first moved to Tanzania and we were sitting there, this was right after 9-11,. We'd moved into this place, the dust was all over and I thought my God, what have we done? And I read. I read novels to escape and to feel good. I used books Survival, wonderful, and so I always wondered if I could write one.
Speaker 2:I've always loved to read fiction. So when we came back I decided to try to see if I could write a book, a fiction book, and the first one they were going to be set in Africa, they were going to be set in Tanzania. I mean, that was sort of a given, because that was so much on my mind all the time and I felt like this is the situation I know so, and and the other thing I know is the health systems, so they were obviously going to have to have to do with the health systems. So the first one was about two women in Tanzania from very different backgrounds, and one of the important things in there has to do with counterfeit medicine, because this is something we ran into a lot.
Speaker 2:Fake medicine, yeah, which is a big problem. Just someone hanging up a plaque and saying no, not that it's the production of fake pills.
Speaker 1:Just for profit, oh absolutely for profit.
Speaker 2:You make a fortune off that because medicines are expensive. So either the pills have talc or something. Maybe that's harmless, or sometimes they have things that actually are harmful. But what they don't have is whatever the active ingredient is that's needed, and children, adults, die all the time from fake medicine. Big problem, Anyway. So that was the first book, Wow. And then the second book was I decided I wanted to do it from the point of view of an American public health specialist whose brother happens to be an ophthalmologist. So it's more of a mystery kind of thing. He goes missing and you know she has to figure out what happened. So it was a lot of fun doing those books. I had a lot of fun doing it. Yeah, I'm not. I don't have a third one going at the moment.
Speaker 1:Can we find them on Amazon?
Speaker 2:Oh, absolutely. That's probably the only place you'll find them.
Speaker 1:What are the titles?
Speaker 2:The first one is called Crossing Paths and the second one is called Distorted Vision. Wow, I like that title.
Speaker 1:That is a cool title Very great learning experience too.
Speaker 2:Really gave me a much greater appreciation for what is involved in writing fiction.
Speaker 1:Yeah, and kind of a departure from scientific writing.
Speaker 2:Oh, very different and harder. Actually I thought yeah. A lot more decisions, oh there's so many more aspects to a fiction book than there are to writing a scientific paper.
Speaker 1:Yeah, what, what, what if I were to go and go to the the Kilimanjaro? Center for community ophthalmology and ask people there what both of your legacies are, what would they say?
Speaker 3:well, there is a picture of both of us hanging up on the wall. We know that since we've been back and well, that's a good thing.
Speaker 3:That's a good thing to say that when we went back and I saw that, I started crying yeah yeah, and I think the the, I think the legacy we have with the staff and when I say the staff, we hired people bit by bit over time.
Speaker 3:We don't have a huge staff, we have probably about 10, 12 people, so it's not a large group. Those people are still working for KCCO, so they've been working for the organization for 20 some odd years now. They, I think what they would say our legacy is is that we did not see any ceiling in them and that we worked to build up their capacity and we them and we pushed them as far as they wanted to and could go. And so somebody like edson elia, who is the country director in tanzania you know he is he now manages all the staff. He goes to Madagascar and all these other countries where KCCO works and he does training and he's basically taken over a lot of the activities that we used to have to do directly. And so I would say maybe the legacy is that people have taken on those skills and taken on those responsibilities and they've run with it. It's now their organization. It's not our organization, it's their organization and I mean it's going to change.
Speaker 2:That's the way it is, but they've made it happen in their own way, and so I would say that's probably the best way to put it is that they've taken the skills that we worked with them on over time and made it their own. Yeah, I was kind of thinking somewhat facetiously. Well, I hope they've all figured out now that when we demand receipts for things, it's not because we don't trust them. It's a matter of good business.
Speaker 1:Good bookkeeping, exactly.
Speaker 2:Because that's kind of one of the cultural things. It was very, very different that we had to accept, and they had to accept working for Wazungu, which is what we are.
Speaker 3:Foreigners.
Speaker 2:Foreigners, yeah, yeah.
Speaker 1:It's a really poignant example, kind of, of this concept of servant leadership where you build capacity and then you can step back or step to the side and there'll come a time in the future who knows how long in the future, but someone will will just claim that work as their own and, and you know, your picture will be on the wall. Hopefully it stays there on the wall, but but the beauty of it is that it, it, it creates its own forward momentum.
Speaker 3:Yeah, uh, into the future, yeah and you know, when you step back from an organization you have to be willing to truly step back, not partially step back. You have to step back and let people run with it and make it up their own organizations to really give up and make that decision, to trust people to run with it.
Speaker 1:The founder syndrome, exactly.
Speaker 3:That's what we call it in the charter school world, right.
Speaker 1:Well, it's the same for us. It's been your baby, and then it grows up, it becomes a teenager, and then it's in college, and then it's got a job and you still want to check if it brushes its teeth every night Exactly. So what was the impetus for retiring? Because you both look so youthful, I would have thought you could have just kept it rolling.
Speaker 2:Well, you know, you get a bit tired of it. It's not, I mean, it's hard. There were challenges, there were things I was quite ready to leave.
Speaker 1:There are political issues. Yeah, I'd imagine. I didn't ask about politics, but I'd imagine.
Speaker 2:Yeah, I wouldn't talk about it either, but they were there.
Speaker 1:Yeah, I'm sure they were there so you know some of that stuff.
Speaker 2:I was just glad to wash my hands of it and walk away.
Speaker 3:Yeah, I mean, I could have stayed on longer than Susan.
Speaker 1:That's just again the personality difference. You're the big picture guy and she's like this detail. Where's my receipt? Yeah.
Speaker 3:But I think we also recognize that we had to step back if the organization was to continue to grow. I just think that founders must step back at some point in time, and if you don't, then the people that you've trained up will say you know, will we ever have a chance to make this our own? And so I think we felt that it was necessary to do that. Without doing that, it would have created more problems.
Speaker 2:And you probably are going to ask us why did we come to San Diego?
Speaker 1:Well, I actually was wondering. I'm assuming part of it was probably the weather.
Speaker 2:Those were the three top reasons.
Speaker 1:Weather weather and weather Weather, weather weather.
Speaker 2:And we really like it.
Speaker 1:Yeah, it's a little unseasonably cool right now, but maybe you were relishing something like that.
Speaker 2:Well, no, it's like the best places we lived in Africa Okay.
Speaker 1:We had beautiful is that how tanzania is?
Speaker 2:well, tanzania is huge and if you're on the coast it's a lot different than in the mountains. We are at the foot of kilimanjaro. It was very similar to this. Yeah, no heat needed, 3 000 feet, so it's an upland climate very pleasant.
Speaker 3:Yeah, we had a fan at the end of the bed, but that's it. We didn't need any air conditioning, didn't need any heating lovely climate so you just look.
Speaker 1:Well, you'd both been in california previous, right northern california.
Speaker 1:So um, well, you've been extremely generous with your time and your stories and your reflections. Um, is there anything that I have? One last question for you, but before I get there, is there anything that we haven't talked about, that you've been like I'm wondering if he's gonna ask me that or this is kicking around in my head, nope, so the last question is a hypothetical. And imagine that you have a chance to design a billboard for the side of a. Well, you're in San Diego now, so we're going to make it the 15 freeway. What does your billboard say to the world about what you believe is important? So you get the chance to extend a message to the world and it kind of synthesizes your values, what you think is important, what people should know, and really distilling your life's work and obviously your life's work isn't done, it's changing. But what does your billboard say? And you can take this collectively or you can take it separately.
Speaker 2:Something about focusing on the important things.
Speaker 3:And I would probably say get out and challenge yourself and explore the world, because it's just an amazing place and you will grow, you will relish that environment and you'll come away a much a person with a much better understanding of yourself, as well as the whole world that's great.
Speaker 1:You need two separate billboards, apparently.
Speaker 3:We need two separate billboards. Apparently, we need two separate billboards.
Speaker 1:What's important and also get out and explore and challenge yourself.
Speaker 2:That is what's important. It is yeah.
Speaker 1:It is, yeah, right, and get rid of what's not important, right, yeah. Yeah, you know that must be an interesting. We could go on all day thinking about the adjustments, coming back to a place like San diego and the excesses that we have in this country and having to try to prioritize, find the essentials and not fall into traps of trying to accumulate endlessly. So, um, I really appreciated this conversation and I very selfishly, you know, I've been trying to push my daughter which never works when you, when your kid's 22 years old, pushed my daughter into a Peace Corps type of an adventure. So maybe when she listens to this episode, that'll kind of help. Both of your stories may help motivate with that. So thank you so much for your time and your wisdom today. I really appreciate it.
Speaker 2:You're most welcome.
Speaker 1:Thank you for listening to the Superintendent's Hangout. You can follow me on Twitter at DVS1970. Please be sure to share this show with friends and family on social media and in the real world. Thank you to Brad Backeal for editing and production assistance and to Tina Royster for scheduling and logistics. Thanks for hanging out and have a great day.