Columns

Jack Lessenberry

Healthcare Lessons
from Nepal

January 27, 2012

BLOOMFIELD HILLS — For nine months of each year, Dr. Richard Keidan is an elite physician in an upscale Detroit suburb, a surgeon who specializes in removing cancer.

But every three months or so, he flies across the globe to Nepal, lands in Katmandu, and then trudges into the interior. He climbs mountains, endures high altitudes and stiff winds, and then pitches a tent among the primitive huts of villagers.

And for the next month he tries to do what he can to improve public health, medicine and hygiene in rural Nepal, through the organization he began three years ago, the Miles Levin Nepal Foundation for Health and Education. “This is really my life’s work,” he said over lunch a few days ago.

Yes, he is a surgical oncologist, and by all accounts a superb one. Keidan is head of William Beaumont Hospital’s multidisciplinary melanoma clinic. He has written dozens of scientific articles, and is a professor of surgery at two medical schools, Wayne State University and Oakland University’s new school of medicine.

But his heart is more than 7,500 miles away, with his Nepalese foundation partner, Namgyal Sherpa, who has led many an expedition up Mt. Everest (and then gone back to retrieve the bodies and gear of those who didn’t survive).

And though he was trained to perform some of the most elite surgery, Richard Keidan has come to believe that those in charge of practicing medicine in this country might learn something from the situation in Nepal. For one thing, he believes the best thing any society can do is invest in basic medical care.

“Maybe I should say public health even before medical care,” said Keidan, a 56-year-old graduate of the University of Michigan.

If you’ve watched a number of the GOP presidential debates this year, you might have the impression that physicians unanimously hate what the candidates sneeringly call “Obamacare.”

Not so. “I may be in a minority among my colleagues at Beaumont, but I am a strong supporter of President Obama,” Keidan said. “It is absolutely indefensible that people don’t automatically have access to primary health care in this country.”

If he has a criticism of the Patient Protection and Affordable Care Act, it is that there is too little understanding of what it does.

He does understand what Nepal needs. “You get a far bigger bang for your buck by putting money into primary care and, especially, public health services,” he said.

What Keidan doesn’t do in Nepal, surprisingly, is surgery. Doctors have often traveled to developing countries to provide medical services for a few days or weeks at a time. This physician thinks that’s the wrong idea. “You help a few people, yes. But when you leave, nothing really changes.”

Instead, he and his foundation are in the business of helping the rural Nepalese to help themselves. They are building a new school in a town called Dipru, and helping kids pay to attend it.

Keidan and his allies are working hard at constructing toilets in every home and school in another town called Dipsung, as well as a hydroelectric project in a town called Rakha.

And perhaps most importantly, the foundation is working with a new medical school called the Patan Academy for Health Sciences, designed to train doctors in rural settings, doctors who then promise to spend at least four years in rural areas.

Interestingly, there’s been some talk in Michigan of the need to launch a similar project to bring family practitioners to rural areas.

Richard Keidan has been in love with Nepal, a nation of 30 million in a space slightly larger than Michigan, ever since he took a year off as a young doctor trying to find himself, and trekked through it with Betsy, who is now his wife, nearly three decades ago.

He got the idea for his foundation gradually, after he noticed that, “the vast majority of people live in rural areas, don’t have access to a physician and may never see one.” Instead, the government provides a network of rural health stations, staffed by workers who may have from two to eight years of rudimentary medical training.

The foundation itself was named after a young Detroit boy who became famous nationwide after he was diagnosed with fatal cancer at age 15 — and wrote a plucky blog about his battle with the disease.

The night he died in 2007, just weeks before his 19th birthday, CNN’s Anderson Cooper told the nation, “Miles Levin was a friend of mine.” Keidan knew Miles, and named the foundation in tribute.

He also knows that most people in Michigan think they have medical care vastly superior to that of Nepal’s. What they don’t know is that the emergency room of his hospital is frequently filled with those who have no money, medical insurance or any other way to see a doctor.

Nor do they know that there are parts of Detroit, and the Upper Peninsula, that might well benefit from a few Nepalese-style health stations, and even benefit more from better standards of public health.

Thousands of villagers and officials in Nepal are learning from their new sherpa, a tall doctor from Detroit. What few may know is that medicine in the doctor’s own country has a way to go, as well.

Veteran journalist and national Emmy Award winner Jack Lessenberry teaches at Wayne State University, serves as Michigan Radio’s senior political analyst and writes regularly for several publications. He also serves as The Toledo Blade’s writing coach and ombudsman and is host of the weekly television show Deadline Now on WGTE-TV in Toledo.