By Helen Garey
Shortly after finishing his major clinical year at Columbia P&S, Dylan O’Connor’17, president of his medical school class, was packing his bags.
A previous two-year Peace Corps assignment at a clinic in Tanzania had solidified Mr. O’Connor’s resolve to become a doctor. At Columbia, he was eager to supplement his medical studies with a hands-on international project that would satisfy his passion for global health and development.
“When I came to Columbia, I knew that global health was going to be part of my package,” says Mr. O’Connor. Right off the bat, he scheduled a meeting with Stephen Nicholas, MD, professor of pediatrics and population and family health at Columbia University Medical Center (CUMC), dean of admissions, and head of the global health track for scholarly projects, to let him know of his interest in studying abroad.
Luckily, Mr. O’Connor encountered a small group of students during orientation who had similar interests. The group met with Dr. Nicholas to discuss opportunities for research, internships, or scholarly project work in areas of the world with limited health care resources and infrastructure.
But despite Columbia’s long-standing tradition in global health research and service, funding for such projects had shrunk. Dr. Nicholas resolved to find donors to allow more students to participate in Columbia’s international programs, such as the International Family AIDS Program (IFAP), the International Center for AIDS Care and Treatment Program (ICAP), and Universidad Nacional Pedro Henriquez Urena (UNPHU).
Good News, Bad News
Not long after meeting with the students, Dr. Nicholas shared some good and bad news for the group. The good news was that he had obtained funding to send two medical students to work with IFAP in the Dominican Republic. The bad news was that because Mr. O’Connor didn’t speak a word of Spanish, he was ineligible.
But just as one door closes, another frequently opens. In fact, Dr. Nicholas had a special opportunity for Mr. O’Connor that would build on his experience in Africa.
According to a 2007 World Health Organization report, doctors and nurses in sub-Saharan Africa go to more developed countries for training, but few return home. This practice has led to an acute shortage of health care workers in the region, which has fewer than one doctor for every 10,000 people. One solution, they proposed, was to build several new medical schools in sub-Saharan Africa.
The idea dovetailed with Columbia’s desire to partner with medical schools in resource-limited settings. In 2013, Wafaa El-Sadr, MD, University Professor and ICAP founder and director, and Lee Goldman, MD, CUMC Chief Executive, visited several ICAP affiliates in Africa. They focused on the tiny southern African nation of Lesotho (pronounced ‘Le-soo’-too’), which had sought ICAP’s advice on developing a medical school there.
A few months later, P&S sent Dr. El-Sadr, Katherine Nickerson, MD, professor of medicine at CUMC, Ronald Drusin, MD, vice dean for education, Lisa Mellman, MD, senior associate dean for student affairs, and Joseph Haddad Jr, MD, special assistant to the dean for international affiliations, to assess the project. After meeting with Lesotho’s Ministries of Health and Education, Columbia agreed to serve as the main technical adviser for the Lesotho School of Medicine (LSoM). This entailed assembling a technical working group composed of medical education experts and participating in workshops to develop a curriculum and build the school’s faculty.
The plan was to bring Basotho (meaning ‘from Lesotho’) students who were engaged in a three-year course of premedical studies in Zimbabwe back to Lesotho for two years of clinical training. The school would be housed in a new, state-of-the-art tertiary care hospital in the nation’s capital, Maseru.
But first, the school needed someone who could work with its founding dean, ‘Musi Mokete, MD, and the technical working group while coordinating with P&S. Mr. O’Connor jumped at the chance to be involved, despite having just three months to complete the first-year curriculum before the students arrived in Lesotho.
“It was a big task, but we decided to develop the curriculum in phases,” he says. “Our goal was to produce general practitioners—known as medical officers—to address the most basic needs of the local population before moving into their internships.”
Mr. O’Connor and the technical working group held a series of workshops with Boyd Richards, PhD, director of the P&S Center for Education Research and Evaluation, and Stephen Canfield, MD, PhD, assistant professor of medicine at CUMC; representatives from the Ministry of Health, the National University of Lesotho, ICAP Lesotho, and Queen ‘Mamohato Memorial Hospital; and local doctors. Soon, they began hammering out a curriculum for LSoM.
Despite their rapid progress, significant obstacles began to emerge. The Ministries of Education and Health disagreed about who would finance and oversee administration of the school.
Meanwhile, the political environment in Lesotho was growing more unstable. On Aug. 30, 2014, two days before LSoM was scheduled to open its doors to 32 students, a military-led ‘coup-like event’ prompted Prime Minister Thomas Thabane to flee the country.
Amidst uncertainty about what was happening, Mr. O’Connor continued to prepare for orientation, and the school opened its doors on Sept. 1 as planned, with 32 students. But by then, the police had fled, fearing military reprisals, and the U.S. Embassy asked all nonessential personnel to leave.
A few hours later, Dr. Drusin called with some unwelcome news. “Basically, Dr. Drusin said I had to leave Lesotho until the political situation improved,” explains Mr. O’Connor. Reluctantly, he headed to Ladybrand, a South African town 18 kilometers over the border where ICAP had facilities. Operating from his hotel room for the next four weeks, and with daily calls from Dr. Drusin, he remained focused on getting the school opened as planned.
“This was our approach to the whole project,” he says. “The doctor shortage in Lesotho is so severe that creating the school was considered an emergency.”
Mr. O’Connor remained in Lesotho during the first year and a half of the school’s operations, returning to Columbia in February 2016.
Mr. O’Connor will begin to wrap up his medical studies, two years behind schedule but satisfied with his accomplishment. The two-plus years spent working with Dr. Mokete will constitute his scholarly project—an in-depth, mentored project that many students take on during their fourth year of electives. Mr. O’Connor is also applying for an MD/MS degree in biomedical sciences with a focus on global health. For his thesis, he plans to return to Lesotho in the fall to evaluate the implementation of the curriculum.
“My experience in Lesotho was truly transformative,” he sums up. “It showed me how fortunate I am to be at a medical school that’s almost 250 years old, and why it’s important for institutions like Columbia to guide the development of new schools. We know the world needs more doctors. Now we just have to act accordingly.”