Profile: Dr. Frank Bia, Medical Director of AmeriCares
Doctor Frank Bia
Frank J. Bia, MD, MPH is a man poised at the junction of thought and action. He is, on the one hand, Professor Emeritus of Internal Medicine (Infectious Disease and Clinical Microbiology) at Yale University, where he has advanced the teaching of tropical medicine for over thirty years; on the other, he is the Medical Director of AmeriCares, one of America’s largest humanitarian aid and disaster relief organizations, where he translates scientific information and research into a force to assist those in need worldwide. His extensive career, spanning more than three decades, has been characterized by a unique synthesis of practice, research and education in clinical tropical medicine, which has altogether brought an exceptional clarity in his work.
He sits with Bharat Kumar to discuss the challenges and opportunities in global health care and the role that the emerging generation of globally-conscious physicians promises to play in the future of global medicine.
What exactly do you do as AmeriCares Medical Director? What are your duties?
The position of Medical Director entails several congruent responsibilities. To begin with, I’m responsible for facilitating the approval or rejection of products donated by medical supply manufacturers and pharmaceutical companies for worldwide distribution. AmeriCares, and most other humanitarian organizations, work hard not just to deliver humanitarian aid to the maximum number of people, but to ensure that such aid is effectively and efficiently bringing improvements into people’s lives. This also requires careful selection of our partners abroad, and establishment of long-term relationships with them. Just like elsewhere, the capability of humanitarian organizations lies very much in their integrity. So as Medical Director, I always aim to work with partners, be they ministries of health or other nongovernmental organizations (NGOs), with whom we can confidently focus on our mission, and from whom we can expect reciprocity.
Our medical team is also responsible for facilitating appropriate distribution of pharmaceuticals and other medical supplies to our partners. I maintain close contact with our various global medical teams who manage our longstanding partnerships and frequently receive “needs lists” from these partners. Because there are always limited resources, discussions take place and plans are then implemented, based on AmeriCares and international guidelines so we can truly deliver what is needed. Following that, a shipping manifest is composed and approved by our recipient partners, after which we can transport the goods to them.
It’s important to emphasize that this isn’t a desk job. There are many phone calls and e-mails involved, but nothing substitutes for actual travel to our partner and recipient sites. So I get to see, firsthand, the work being done by our partners and review both ongoing and potential projects directly, to ensure that donated medicines and supplies are getting where they are supposed to be going. Besides that, I also provide weekly medical seminars for the entire medical and nonmedical staff at AmeriCares and continue to maintain clinical skills through my work at one of the three AmeriCares Free Clinics for the Uninsured here in Connecticut.
What prompted you to shift gears and move from academia to humanitarian work?
It’s not really as drastic a change as you might think. It’s more like a continuum of more than 30 years of work that I’ve been doing internationally. At AmeriCares, I’m using my expertise in a different, and probably more direct, way. In the academic world, the negotiable currency is grant funding for research, so that scientific advances can follow. My concern has always been skewed slightly differently – to both educate the next generation and to work for more equitable health care and social justice. So it’s really a natural move for me to evolve into this type of work at a later stage in my career.
By social justice, what exactly do you mean?
It comes down to the reason why I became a doctor in the first place. I never considered it my right to go to medical school and practice medicine. Instead, I felt it was a privilege. What followed was concern about upholding the rights of my patients to have good health care. During my residency years, I was imbued by my mentors, particularly Dr. Samuel O.Thier, with the idea of a “social contract”, in which members of a society assume responsibility for each other. Many of the problems in global health occur because we do not hold up to this responsibility – the social contract. Our tendency has been to overlook more systemic issues like poverty and injustice. Ultimately, that’s what I mean by social justice – upholding this social contract, even with people we may have never met personally.
Why are people at large interested in giving to humanitarian aid organizations to begin with, especially during difficult times?
Your first instinct may be to say that people donate because they’re altruistic. That’s really not how I see it. I simply do not believe that people do good for others without somehow factoring in themselves. The Russian-American author, Ayn Rand, understood this. People are inherently “selfish” when it comes to giving – they want to help others because they find something for themselves in these acts. Rand considered this the “virtue of selfishness”. I think we have a strong evolutionary drive to uphold social obligations for the betterment of the community. Some people call it generosity or altruism, but if you look at it closely, you’ll find at some point or another that they know they themselves are bettered through their acts.
But that’s individual philosophy. There are many concrete reasons why our corporate donors continue to give. In addition to monetary contributions, they provide “gifts-in-kind” – donating medicines and supplies to aid organizations like AmeriCares. Pharmaceutical companies, for example, incur large inventory and destruction costs. As the Medical Director, I work with our corporate team to acquire any surplus inventory. This in turn empowers our health care partners around the world to save lives and restore health to people in their communities who often lack the basic medicines, supplies and aid they need to survive.
Good corporate citizenship is another major reason for corporate donations. The US tax codes provide tax incentives for companies that donate to humanitarian causes. But even this may be the least of it. After all, large pharmaceutical companies aren’t soulless organizations – they have employees who demand that they work for the greater good – again, the social contract. So management might actually view donations as investments into their own human resources.
What exactly are the roles of government and politicians in humanitarian work and disaster relief?
A good question. There’s no clear-cut line between the roles of government and NGO’s, but the motivations may be entirely different. A government’s motive for aiding others may be to help ensure the security of its own citizens. NGOs, on the other hand, are freer to set their own agendas, since our motive is self-determined. We are essentially beholden to our donors and partners, as well as to our own mission and vision. However, these roles are complementary and the best results occur when governments and NGOs can work harmoniously.
But what about when governments aren’t working in the best interests of their citizens? How do humanitarian groups deal with such situations?
AmeriCares has the expertise in delivering medicines to isolated countries, including North Korea, Sudan, Iran and Myanmar. Our emergency response teams establish relationships with high-level officials within government ministries to secure necessary approvals so we can deliver aid quickly and efficiently directly to the people who need it. We team up with local health care organizations and even governmental organizations so our work isn’t seen as a threat to government sovereignty. These contacts are instrumental in building the trust necessary to enter such places. For example, when Cyclone Nargis hit Myanmar in 2008, we were able to steer our way through via our various NGO and governmental contacts. Indeed, the Myanmar government may have been suspicious of the outside world, but AmeriCares and that government had some history. Permission to land the airlift in Yangon and authorization to maintain custody of the cargo were acquired very quickly. We remain in Myanmar, building on such confidence and engaging the government so that we can provide long-term relief to the victims of the cyclone.
We do face frustrations. After our plane landed on the tarmac, AmeriCares had to negotiate persistently to maintain control of the cargo and to oversee distribution to local partners. The international aid community has heard many stories about government intervention into the work of humanitarian aid groups. So yes, the realities aren’t always so rosy, but we adjust accordingly.
Is there a fear of appearing imperialistic when engaging in humanitarian relief?
Of course there is, but those ”imperial” situations don’t occur very often or last very long. If you act that way, you’ll get shut out quickly. In humanitarian work, it is really important to demonstrate respect for your recipient partners. They generally know exactly what they need, and our job is to deliver what we can.
Do you feel that the HIV/AIDS pandemic has sucked the air out of the room for other diseases?
AIDS is a very pressing issue, especially in Africa, so I entirely understand the emphasis on AIDS. AIDS has many social imperatives, and it is without a doubt an additional strain on an already ailing continent. The international community should work to reduce the burden of AIDS. At the same time, we cannot lose focus on other diseases such as malaria and childhood pneumonia and recognize how they fit into African priorities. With that said, in my experience, there really isn’t a conflict between resources for AIDS and other diseases except at the level of funding.
What is the greatest challenge in international health care for the emerging generation of doctors?
It is really encouraging to experience that intense interest among young doctors in global health. I’ve found that students are incorporating new mosaic pieces of their lives into their future practice of medicine. Students are working around the world and understanding global dynamics, often even better than their mentors. In terms of the field itself, I believe that the problems today may seem overwhelming because the world is so much smaller and accessible. Telecommunications technology has made it possible to see the entire world – warts and all. The other side of the coin is that we are more aware of global problems, and can react better. Perhaps just as important is the individual student’s challenge in maintaining balance. But you must do this, and the reward is making your personal impact on the wider world.
Do you have any advice for aspiring physicians in the field?
Follow your passion. Share what you love. That’s the only way to keep on going when the frustrations hit.
What direction is the field of global health heading in?
Honestly, I don’t know, and I don’t think anyone really does know. However I believe we are now more globally engaged than ever before, and that makes it more exciting than ever.
Bharat Kumar is a 3rd year medical student at the Saba University School of Medicine
bharatk@alumni.upenn.edu