In addition to working at Duke Medicine’s Sutton Station Internal Medicine Clinic, Ronald Halbrooks, MD, consulting associate in the Department of Medicine, has practiced medicine on three continents.
In this week’s faculty spotlight, Dr. Halbrooks talks about working in Ethiopia’s during the country’s famine in the 1980s, helping a Chinese hospital prepare for the 2008 Olympics, and the reason why he’s traveled to Australia more than two dozen times. He also talks about following in the footsteps of his father, an anesthesiologist who traveled to Africa, Asia, and the Middle East.
[Note: Be warned–the end of this article contains a photo that may be upsetting for some readers.]
How long have you been at Duke? How long have you been at the division?
I’ve been at Duke from 1995 to 1999 and from 2006 to the present, always at Duke Primary Care.
What are your responsibilities within the division? What does a typical day for you look like?
From 2006 through 2011 I was the lead physician at Sutton Station Internal Medicine and Galloway Ridge; I was also a clinician. The rest of the time I had clinical responsibilities. I’m still at Sutton Station, where I see about 22 patients a day. I also lead the CME at Sutton Station and help with clinical trials. In my clinic I teach nurse practitioner students, medical students, Duke-NUS students, and internal medicine residents.
You’ve practiced medicine for extensive periods in both China and Ethiopia. What was those experiences like? What was the most memorable moment you have practicing in each of those locations?
I worked in Ethiopia from 1986 to 1988 during the large famine of the late 1980s. The area was very rural with no running water, electricity, plumbing, or communication. The NGO I worked with fed 600,000 people a month for four years. Transportation was by helicopter and plane due to no roads. I was the medical relief coordinator and was responsible for nutritional data gathering, staffing the seven clinics and equipping with medicines and other resources and triaging difficult patients to Addis Ababa.
The work was very hard but rewarding in the sense that we reduced the under-five-year-old rate of mortality from starvation (which is the best way to gauge a famine) from 50%, which was the baseline then, to 5%. We were able to triage many women with fistulas from birth complications; we were able to give most of them immunizations. We also did veterinary work for the animals and reforestation and spring capping projects.
China was completely different. When I went to Ethiopia I was single (I met my wife there and married). When we went to China, I went with my wife Mary as well as our four little girls. It was also different in that we were in a very urban and modern Chinese city called Qingdao on the Northeast coast. Learning Chinese was very hard but we managed to do well. My work there consisted mostly of working in a large Chinese hospital with over 1,000 beds. I helped them with consults, bringing in specialists (some from Duke). Primarily I helped this hospital (which I still have very close relations with today) with opening an international clinic in preparation for the 2008 Beijing Olympics as Qingdao hosted the sailing venues for the Olympics and the IOC requires an international clinic in each city that hosts venues.
She had no money to give me but what she had, humility before others and kissing my feet in public is what she gave. It was certainly one of the most humbling and yet rewarding moments of my life.
What were your most memorable experiences in each country?
In Ethiopia, we triaged women with fistulas to the fistula hospital in Addis Ababa. Though common today, this was the only one in the world at that time. The women would get fistulas in childbirth and end up totally incontinent as a result.
This injury had even worse repercussions. Because these women ended up smelling of urine, their husbands almost always divorced them and they became social pariahs. I lived up country, about a six-hour drive north, over mostly dirt roads, over Addis Ababa, where the fistula hospital was located.
One day I was in the compound in Addis Ababa, in a coat and tie for for a meeting, surrounded by 50 or so Ethiopian men working moving grain and fixing broken trucks. Out of the corner of my eye a woman slowly came towards me in the midst of this sea of men. As she moved towards me the men in the compound shifted their eyes from their work to this woman (probably in her mid 20s) approaching me.
As the women came within a foot or two of me she knelt to the ground and kissed my feet in front of all of these men. Because we saw so many people each day (over 100 a day) I had forgot her face until one of the lead workers I knew told me she was one of the ladies I had triaged down to the fistula hospital months ago.
I had seen her in one of the rural clinics and now she was healed of her fistula and the smell of her urine and had her sense of dignity restored. She had no money to give me but what she had, humility before others and kissing my feet in public is what she gave. It was certainly one of the most humbling and yet rewarding moments of my life.
In China, I would say that working with residents in their training was very rewarding as they had no money, lived in very poor dorm settings but were very eager for friendships and wanted to help me learn the Chinese language. Those friendships are still very deep and meaningful to this day today.
Have you practiced medicine in or traveled to any other countries?
I have traveled to Australia about 20 times as my wife is Australian and has family there. I have traveled to countries in South America, Europe and other countries in Asia to about 30 countries total. I have only practiced in the U.S., Ethiopia, and China.
In your Duke Medicine profile, you talk about entering medicine in part because of your father, who was an anesthesiologist. What lessons did you learn from his practice?
My father worked 4 months a year each of the the last 6 years of his life (he died when he was 47 years old) overseas in hospitals. He worked in Africa, Asia and the Middle East. He helped with developing nurse anesthetist programs, helping with hard cases and doing cme for the surgeons; many who did their own anesthesia. I learned from him the sacrifice needed to achieve a cause and a passion for the poor and needy overseas in resources poor areas.
In your profile you also discuss addressing your patients’ emotional and spiritual health. How do these areas affect your patients’ physical health (and vice-versa)?
I believe humans are not just mechanistic and have not just a physical body but we have a spiritual component of our lives as we are made in the image of God. Many patients want this interaction as a result. An important aspect patients like, especially those with great physical or emotional needs is praying with them. Plus as many patients have a great interest in this aspect of their lives interfacing as a doctor with them on this area helps them to know i care about all of their life and also helps me to know them better and thus better care for them.
What passions or hobbies do you have outside of the division?
Running, biking, swimming, reading, playing the violin and collecting stamps and old newspapers. My family and i love going to movies together.
I work with the medical relief group NC Baptist Men, which has three dental buses and helps with A1c screening on these buses and similar projects in Haiti, Honduras and Guatemala.
Have you recently read any articles, books, blog posts or other material that could be of interest to the rest of the division?
Since my family loves The Lord of the Rings we just read J. R. R. Tolkien’s Letters. I also recently enjoyed The Genesis of Science, which is about the impact the medieval period had on the growth of modern science.
“This photo is of a little girl, probably one or two years old and 60% weight for length in Ethiopia. At that weight no one lives long at all. The mother crying placed her in my arms and i tried to examine her and just at that time a visiting photographer took the picture. The little girl died two hours later.”