R.I. group aids doctors who stay in countries where they're needed
By Elizabeth Gudrais
In the United States, the doctor-patient ratio is 1 to 182, World Health Organization statistics show. In Indonesia, that ratio is 1 to 6,250. In Sierra Leone, 1 to 13,700. In Liberia, 1 to 43,500. And in Malawi, there is one doctor for every 88,000 people. These aren't the only impoverished countries with shortages of doctors. But in those four countries, through a Providence-based nonprofit called Adopt a Doctor, Rhode Islanders' money is augmenting the salaries of individual doctors, helping them to resist the temptation to emigrate for more money. "Doctors can make a better living in the United States as a cab driver than as a doctor in Africa," says Rajiv Kumar, Adopt a Doctor's executive director. Doctors' salaries in those countries are low, not just in comparison with those in the United States, but in comparison to other occupations' earning power. In American society, doctors are highly respected and highly rewarded. It's not that way everywhere. "In Liberia, janitors make more money than doctors," says Ray Rickman, the organization's chairman and president. The consequence: Doctors in those countries leave. After all, parts of Canada, the United States and the United Kingdom are short on doctors, too, and clinics in those places offer perks such as five-digit signing bonuses, rent-free office space and interest-free loans. In Malawi, a doctor makes $80 (U.S.) a month. The work is harder, too - doctors there see 50 to 70 patients a day, two to three times the number an American physician might see. Adopt a Doctor, founded two years ago by Rickman and Kumar, pays each doctor $1,000 a year -- roughly doubling the doctor's pay -- in exchange for the doctor's agreement to stay in his or her native country for seven years. (Without the stipend, doctors leave these countries after an average of three years, according to Rickman.) The group supports two doctors in Sierra Leone, two in Liberia, two in Malawi and eight in Indonesia. The doctors receive are paid every two months through Western Union. The doctors are living "hand-to-mouth, and we double their salary," Rickman says. "We elevate them to a state of genteel poverty. We don't make them middle-class." Many organizations, WHO among them, give money to buy medicine and equipment. Groups such as Doctors Without Borders sponsor visiting physicians who volunteer their time in poor countries, but ultimately leave. Adopt a Doctor pays doctors working in their home countries simply to stay. "We offer them something they can't get anywhere else," Kumar, a 22-year-old first-year medical student at Brown University, says. "Essentially, what we're doing is building sustainable health-care systems." The idea for Adopt a Doctor was born when Rickman heard a doctor in Malawi interviewed on National Public Radio. The doctor spoke of patients dying because he had no medicine to prevent a common cold -- combined with malnutrition -- from progressing into pneumonia. Rickman, a 56-year-old Providence resident who now works as a diversity specialist for the Lifespan hospital network but was then deputy secretary of state, figured there had to be something he could do. What he found astounded him. "There are more Liberian doctors in Newark [N.J.] than there are in Liberia," he says. He picked four of the world's poorest countries, but ones that also have sufficient infrastructure -- health clinics and a banking system -- to support Adopt a Doctor's aims. With money from donors including Brown University and former gubernatorial candidate Myrth York, Rickman hired Kumar -- then a Brown undergraduate -- to spend a summer on the project full-time. And they started asking around. Like most things in life, finding doctors to help was about connections. Americans who live in the sponsored countries "certify that the person is poor and that they're a medical doctor," Rickman says. "That's all we require." Adopt a Doctor received federal 501(c)3 tax-exempt status in September 2003, and made its first transfer of funds in February of last year. Rickman and Kumar receive reports of the doctors' work in e-mail messages and occasionally in handwritten letters such as this one: "Dear Brothers . . . I am highly delighted in your program for accepting me as the only female doctor for your program in my country, Liberia. I also want to extend my deepest appreciation for the stipend that I received from your organization. I pray and I hope that this will continue as we foster better cooperation between the two institutions. . . . May God bless us all as I continue my work in the rural parts of Liberia. Thanks in advance, Dr. Frances A. King." The problems the doctors face are daunting, for sure. In Adopt a Doctor's African countries, adult HIV infection rates range from 6 percent in Liberia to 14 percent in Malawi. In Liberia, the population's median age is 18. Life expectancy is 48. The infant mortality rate is 129 deaths per 1,000 live births, compared to 7 per 1,000 in the United States. Rickman takes comfort in the fact that without Adopt a Doctor, things would be worse. "This, I think, is the most rewarding thing I've ever done in my life," he says. "Every day, I feel like a child is breathing because of the kindness of people in Rhode Island." In Indonesia's Aceh province, Adopt a Doctor supplements the salaries of doctors and nurses at a clinic run by the American Overseas Medical Association. Among services the clinic offers: health care for children in internally displaced person camps; a mother-child health program that provides immunizations and supplemental feeding for underweight children; grief and trauma counseling; and preschool education. The program saw 2,500 patients in July, and a total of 19,000 between Jan. 1 and Aug. 21. Lucia Cargill, executive director of the American Overseas Medical Association, visited Aceh last month to watch the clinic in action. In an e-mail message from Meulaboh, where a third of the town's 120,000 people died in last year's tsunami, Cargill wrote: "NGO [Non-governmental organization] Land Cruisers are all over this little town with labels like UNOCHA, UNDP, WHO, UNICEF, IRC/Cardi, MSF, CARE, OXFAM, etc. All the big guys are here, but our little, but formidable . . . team is known all over the city and in every NGO office for their good, consistent work." Now that Adopt a Doctor is established, doctors in the countries where it operates approach Rickman and Kumar. "We have a lot of doctors who e-mail us and ask to be adopted," Kumar says. Adopt a Doctor has a waiting list in Malawi. The organization has enough money in the bank to support its existing doctors for three years, but not the seven years it has pledged. So Rickman and Kumar will wait for the bank balance to grow before accepting anyone new. The Adopt a Doctor charter declares intent to support doctors in Haiti, but that's on hold, too. In the meantime, the organization is three months behind on the rent -- $1,000 a month -- at the organization's office on Waterman Street. "People write and say, 'I want to give $100 for a doctor's salary,' " Rickman says. "They even underline it sometimes." He says donors don't understand that without money for overhead costs and employee pay, Adopt a Doctor couldn't exist, and can't expand. With a full-time staff member, Adopt a Doctor could expand into Kumar's dream -- supporting countries' entire public health systems. But that won't happen "unless an angel comes along," Rickman says. He estimates it would take $55,000 a year. For more information, visit www.adoptadoctor.org
Published in The Providence Journal
Oct. 11, 2005