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‘The Job in Global Health Is Always to Work Yourself Out of a Job,’ Says the Recipient of the AAN Global Health/Humanitarian Award

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James H. Bower, MD, FAAN, has been traveling to resource-poor countries since the 1980s to help improve medical care. For his work, he won the 2019 AAN Global Health/Humanitarian Award.

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When Dr. James H. Bower (standing, fourth from right) first visited Ethiopia in 2001, there were only two neurologists. Today, after years of annual visits to teach, train, and encourage native physicians, there are about 40.

Among the 110 medical papers coauthored by James H. Bower, MD, FAAN, the vast majority are studies of Parkinson's disease. A dozen of them, however, have an unusual focus for the chairman of the division of movement disorders in the department of neurology at the Mayo Clinic in Rochester, MN: They are about the state of neurologic care in sub-Saharan Africa in general, and in Ethiopia in particular.

When Dr. Bower first visited there in 2001, only two neurologists worked in all of Ethiopia. Today, after years of annual visits to teach, train and encourage native physicians, there are about 40.

In recognition of his work there, Dr. Bower was honored at the AAN Annual Meeting this past spring in Philadelphia with the AAN Global Health/Humanitarian Award.

“I am very humbled by this award,” he told Neurology Today, “as there are a lot of us who do this kind of work.”

Dr. Bower's interest in improving medical care in resource-poor countries dates back to 1984, when a famine in Ethiopia prompted the recording of “Do They Know It's Christmas” and the “Live Aid” concerts. He spent a summer while still an undergraduate at Duke University observing medical caregivers in impoverished areas of Brazil. Then, as a senior medical student, he took a two-month rotation to work in India.

“I loved traveling, I loved working in resource-poor areas,” he said. “I know that a lot of people don't want to live or work in that kind of environment. It didn't bother me at all. I found it adventurous.”

In 2000, he read an article in AANnews about another neurologist, who had already visited Ethiopia, and who encouraged anyone interested to contact him.

“I did, and he arranged for me to go,” said Dr. Bower. “Ever since I've been going every year.”

Back then, he said, medical resources in Ethiopia were extremely limited.

“They were still very, very undeveloped because so much money had been spent on the war with Eritrea,” he said. As a result, “There was just one CT scanner in the entire country, and it was predominantly non-functional,” he recalled.

His first visits happened to coincide with the AIDS crisis in Africa. “They had very poor laboratory support, and few medicines,” he said. “I remember one case of a woman, probably in her thirties, but who looked like she was in her eighties because she had end-stage HIV. Western countries already had highly active anti-retroviral therapies, but Africa didn't have it. She was lying in the hallway because all the beds were filled. She was screaming in pain, but there were no opioids. She was grabbing my arm because I was an American, a guy who could save her. But I couldn't save her. That case really haunted me.”

Finding His ‘Calling’

After making a few annual trips on his own, Dr. Bower realized that he had found his calling. “Most of us go into medicine for the corny reason that we want to help people,” he said. “But everybody has different skill sets. Some people love working in the laboratory or running clinical trials. It occurred to me after three or four years of visiting Ethiopia that it was my favorite two weeks of the year. I realized that I should develop this into an academic pursuit. I had been trying to do other things in neurology, but they felt like square pegs in a round hole. For me, working in sub-Saharan Africa was a round peg in a round hole.”

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“I had been trying to do other things in neurology, but they felt like square pegs in a round hole. For me, working in sub-Saharan Africa was a round peg in a round hole.”—DR. JAMES H. BOWER

It was then he took a sabbatical from Mayo to obtain a master's degree in tropical medicine from the London School of Hygiene and Tropical Medicine.

Back at Mayo, he was soon being joined on his visits to Ethiopia by two colleagues, Julie E. Hammack, MD, and Paola Sandroni, MD, PhD. But it was the Ethiopian health care workers themselves, he said, who made the greatest difference.

“One neurologist who is really amazing, Guta Zenebe, really spearheaded the development of neurology there,” Dr. Bower said. “He started the first neurology program with our help, and with faculty from across the world, in 2006.”

Today, the country has not only many CT scans but also “countless” MRIs, he said.

“The job in global health is always to work yourself out of a job,” Dr. Bower said. “We used to teach neurology at the bedside and with lectures. Now when we go back, we help examine their senior graduating residents, because the Ethiopian doctors have taken over the teaching themselves. We also go to smaller medical schools where they have only one neurologist.”

In 2014, Dr. Bower coauthored a paper in Neurology calling on AAN to join with other international medical organizations to support the teaching of neurologic specialties in sub-Saharan Africa. AAN agreed, and there is now a competitive application for an AAN member to attend the course each year.

“It's been exciting to help spread neurology through the world with the involvement of AAN,” Dr. Bower said.

One trend that cheers him is the growing interest among younger physicians in working in resource-poor countries. He recalled that when he was attending New York University School of Medicine in the 1980s, only he and another student out of a class of 180 expressed an interest in global health. Today, he said, “It's now a good 25 to 30 percent of every medical class.”

For those seeking to make a difference, he encourages neurologists to make repeated visits to a single country, as he has done, rather than spreading themselves too thin.

“The best way to be successful in global health is to find one partner and commit to them,” he said.

Link Up for More Information

• Bower JH, Diop AG, Gouider R, et al. Addressing neurologic needs in sub–Saharan Africa: An opportunity for multisociety cooperation https://n.neurology.org/content/83/13/1207. Neurology 2014; 83(13):1207–1209.