Einstein Physician Offers A World of Compassion

When Dr. Carol Harris arrived at Einstein in the summer of 1981 as an infectious disease fellow she was following a childhood dream of becoming a doctor. However, she never could have imagined that her very first weekend on call would launch her on a 30-year journey that would take her more than halfway around the world and touch thousands of people’s lives.

Dr. Carol Harris with Dr. Amha on the AIDS wards at ALERT Hospital During that formative weekend, she cared for a patient — a gay man with a strange pneumonia. He was the first of many such patients she would see that summer. The trickle became a flood and eventually the disease had a name: AIDS. At the time, its only outcome was certain death.

“Carol was one of the very early people to get involved before we knew what the cause really was,” said Dr. Milford Fulop, who was director of medical services at Jacobi at the time. “We just knew it was a dreadful disease that was killing people — killing a lot of young people.”

No one knew how the disease was spread. They only knew it was a death sentence.

But Dr. Harris did not let the rampant fear come between her and her patients. “In those early days of AIDS,” said Dr. Stephen Baum, who was then a director of the infectious diseases division, “when people were wearing three masks, three gowns and three pairs of gloves even to serve them a tray of food, Carol was embracing them physically and philosophically.”

Her dedication and zeal led to an interview with on ABC-TV’s Nightline, which attracted the attention of philanthropist Joan Kroc. As a result, Ms. Kroc made a substantial donation to establish an AIDS clinic in the Van Etten building of Jacobi Medial Center, adjacent to the Einstein campus.

“From then on, Carol has been dedicated to treating people with AIDS,” said Dr. Baum. “And, she single-handedly set up a global health education program in Ethiopia and launched the global health initiative that takes our students there.”

Dr. Harris’ work in Ethiopia began in 2002, when she was invited to run the first AIDS awareness conference in Addis Ababa. While in the capital, at the request of Ethiopian physician Dr. Agonafer Tekalegne (now the in-country program director for Dr. Harris’ activities), Dr. Harris visited a young AIDS patient in one of the city slums. The 12-year-old girl was in acute respiratory distress and there was nothing to be done. “That night, she died,” said Dr. Harris, “and it was a horrible, horrible death.”

At the young girl’s funeral, Dr. Harris was overcome with sadness. “AIDS puts a bright spotlight on the glaring inequities around the world, the grotesque differences in life expectancy,” said Dr. Harris. “It is unacceptable. These people are dying of preventable causes. The enormity of the suffering over there is just overwhelming.”

However, through the end of the young girl’s life, Dr. Harris found a new beginning. “Dr. Agonafer said to me, ‘Come on, Carol. There are millions more like her who are suffering. We’ve got a lot of work to do.’”

Einstein students during summer 2008; Dimyana Abdelmalek is at far rightThat first visit to Ethiopia has led to the establishment of an expansive network of programs and services throughout the impoverished African nation that are focused on creating and expanding care for the estimated 1.1 million Ethiopians afflicted by the disease.

Through the years, Dr. Harris has returned time and again, providing AIDS treatment education to Ethiopian healthcare providers at medical schools and conferences, training young doctors in the best practices and standards developed over the last 30 years and establishing model treatment programs.

The program has two major components: an intensive collaborative relationship with ALERT Hospital in Addis Ababa, which serves the capital city’s poorest residents; and a multi-faceted relationship with one of only six medical schools in the country, the Hawassa College of Medicine and Health Sciences in southern Ethiopia. Her goal is to help the Ethiopians build their human healthcare capacity with people who are well-trained and invested in Ethiopia’s future.

“Living and working alongside Ethiopian physicians brought their overwhelming issues and needs into focus and sharpened the cultural prism through which care had to be offered,” said Dr. Harris. “For instance, in the States, vertical transmission of HIV from pregnant mother to child is averted. So, targeting pregnant women for care is a logical first step in halting transmission of the disease.”

But, in Ethiopia, where, more than 94 percent of women have their children at home this is no easy task. As a result they never receive pre- or ante-natal care.

“How can you do HIV testing on pregnant women if they don’t get medical care?” Dr. Harris asked.

Her answer has been to help create maternal care programs both at ALERT and in Hawassa. In addition, with AIDS prevention funding she was able to assist in establishing an obstetrics unit in Addis Ababa, through ALERT, which opened in May 2010. The unit, staffed by six midwives, offers care 24 hours a day, 7 days a week.

“If one of us is going to help them develop, we need to build systems that are theirs that they believe in, so they can take care of their own people,” said Dr. Harris.

But, the obstacles are huge. “You cannot imagine the challenges students and faculty endure,” said Dr. Harris. The students live in bare dorms with unreliable electricity, no bathrooms, and only the most basic of possessions. Many cannot afford mosquito nets to cover their beds. They line up early for lectures hoping to get a seat in the front where they can hear since there are no auditorium and no sound systems for lectures. Textbooks are limited in quantity and antiquated, and only available to read for a few hours a day in the library.

To create more opportunities, Dr. Harris undertakes fundraising for basic supplies, and has established an annual lecture series that presents the latest in medical education to graduating seniors.

One of the first babies born at new obstetrical unit at ALERT Hospital, May 2010Through the medical school’s referring hospital, Dr. Harris is helping establish a network of collaborations and relationships to enhance trauma care with Dr. Mike Coomeraswamy, former Jacobi trauma surgeon; malaria research with Einstein colleague Dr. Johanna Daily and emergency obstetrical care with Einstein colleague Dr. Pamela Tropper. Moreover, just recently, she launched a program to augment the minimal oncology available in Ethiopia.

Such collaborations enrich opportunities for Einstein medical students who take part in the global health initiative led by Dr. Harris. Fourth-year student Dimyana Abdelmalek found that out firsthand when she traveled to Ethiopia during first year as one of five students to participate in the Ethiopia program. “It was easily the most memorable experience I have had in medical school,” said Ms. Abdelmalek.

In addition to intensive, pre-departure preparation from Dr. Harris about Ethiopian culture, gender inequalities, water and sanitation issues, and infectious diseases, Ms. Abdelmalek recalled that the students spent 10 days in the capital of Addis Ababa meeting with representatives from the ministry of health and nongovernmental organizations, acclimatizing and becoming deeply immersed in the big picture issues of HIV and its impact on the country. They then visited a remote village, where they saw firsthand the suffering and need.

“What surprised me most,” said Ms. Abdelmalek, “was the gap between the ‘haves’ and ‘have nots.’ The disparity is much starker in Ethiopia due to the infrastructure.”

At the Kembatta Women’s Health Center, Ms. Abdelmalek shadowed an ob/gyn surgeon. “They didn’t have an anesthesiologist. They didn’t have monitoring equipment. They only had one blood pressure cuff. There were rolling black outs and many days where we didn’t have power. One day, power went off in the middle of surgery.”

She found it a country and culture of “make-do” — with those who could do taking on more than their share. “At one local clinic, there was no surgeon, so the ob/gyn doctor stepped in and did pediatrics and an abdominal surgery for a patient in distress,” she recalled.

The students stepped in as well, assisting with a USAID food distribution during a visit to Hawassa.

The care provided by Dr. Harris and the global health initiative goes beyond just building systems and facilities, though. In every visit to the country, Dr. Harris is at the patients’ bedsides, caring, tending and taking care. “If one is to truly understand the care systems and how to help, we need to be directly involved with the doctors and their patients,” she explained.

“She cares so deeply about her patients,” said Ms. Abdelmalek. “On rounds at the ALERT Hospital, Dr. Harris met someone with HIV and TB and she took the time to give them a reassuring hug and make sure they had everything they needed. There was one patient with sores, and she didn’t just tend to the sores, she stopped and changed all the bed linens, which had been soaked through.

“She doesn’t get all hung up on what they don’t have,” Ms. Abdelmalek continued. “She looks broadly at all the things that can be done, and then goes and does them.”

With each small victory in Ethiopia, Dr. Harris’ work load and her reputation continue to grow. Most recently, she was invited to China as a visiting professor in the Jilin province, where she has been asked to serve as a consultant in the development of a model AIDS care program.

For Dr. Harris, creating and growing global health initiatives is not an end to itself, but a means — a means to make things better and change the world. For example, when she established the Einstein Institute of Global HIV Medicine in 2001, she had a distinct mission: To break the barrier of ignorance and improve the quality of life.

To achieve that the program is focused on teaching AIDS medicine while attempting to understand and describe cultural, economic, and political barriers impeding the implementation of AIDS programs and to act as a force for change that can enhance HIV/AIDS prevention and treatment by the development of model programs.

“I want to build it into something that will outlive me,” she said.

“She is one of the most dedicated, ethical, righteous people that I know,” said Dr. Baum, who was responsible for bringing Dr. Harris to Einstein so many years ago. “She is the closest thing to a saint that this institution has.”

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