Helping to bring health to Afghans


Spotlight// Dr. Gil Burnham

August 27, 2006|By David Kohn | David Kohn,Sun Reporter

As a U.S. Army physician working in South Korea in the late 1960s, Dr. Gil Burnham took care of sick and injured GIs. But as an unofficial side project, he and the group of medics he supervised spent most weekends traveling the South Korean countryside, caring for villagers.

"I discovered I could order any amount of medicine through the Army supply system, and nobody asked questions," Burnham says. "There was a huge amount of tuberculosis, so we started these TB clinics."

He had found his calling. "After about six months, I thought, `I really like this. Can you do this for a living?' "

The answer, it turns out, is yes.

A professor of international health at the Johns Hopkins University Bloomberg School of Public Health, Burnham has spent much of the past four decades working all over Africa and Asia, helping very sick, very poor people.

"He's made it his life's work," says his friend David Peters, a Bloomberg professor and collaborator on a venture to help rebuild the health-care system of Afghanistan, one of the least healthy countries on the planet.

Burnham and a staff of 26, many of whom work in Afghanistan, are literally part of the country's Ministry of Public Health. They have offices in the headquarters in downtown Kabul and meet regularly with top officials. Their job: to provide health data to the ministry, which has little experience undertaking health research.

He is based in Baltimore but has made 15 trips since the project began in 2002, usually traveling around Afghanistan to see firsthand how the work is going.

"I've been in the field with certain people who never get out of the Land Cruiser," says Dr. Ayan Noor, who until recently was the in-country manager for the project (she now works in Liberia for the U.S. Agency For International Development). "Gilbert is always the first one out, bounding ahead of us."

A tall, lanky man with a trim beard and horn-rim glasses, Burnham, 64, has the air of a wry academic. Noor says that on trips around Afghanistan, people invariably ended up calling him "Professor."

Since the United States ousted the Taliban regime five years ago, millions in international aid from the United Nations and the World Bank have been devoted to rebuilding Afghanistan's health-care system.

For the past four years, Burnham's project has been advising the Afghan government where it should focus its efforts. The funding for the project - about $2 million so far - comes from the government, which receives the money from the World Bank.

Burnham's group tracks statistics such as infant mortality rates, patient and health worker satisfaction and the percentage of prescription drugs that are counterfeit or substandard. This information plays a key role in shaping the fledgling health-care system.

Dr. Faizullah Kakar, acting minister of public health, says in an e-mail that Burnham is a "valuable addition to the ministry," and calls him "courageous and dedicated."

Their work has already produced tangible change. For example, the Afghan government increased resources to fight tuberculosis after researchers reported that health clinics and hospitals offered little treatment and kept poor records. Such records are especially crucial because most TB patients require careful daily care. "This is not just an abstract exercise," says Peter Hansen, director of the project's Kabul office. "Our findings lead to concrete results."

Burnham sees signs that health care is improving: Patients are getting better treatment, the number of health workers is growing, and training is more widespread. The next problem he hopes the project will address is the state of hospitals, which remain severely understaffed and underequipped.

The project was started by Burnham and Peters. They began studying a few provinces, but the Afghan government asked them to cover the entire country. Peters now works mostly at the World Bank, and devotes less time to the project. Burnham oversees the day-to-day work, communicating constantly by e-mail and Internet phone with colleagues in Afghanistan.

Research has become more difficult as Taliban fighters have reasserted themselves in large swaths of the country. According to the United Nations, the number of security incidents - bombings, shootings, etc. - were greater last month than at any time since the fall of the Taliban in 2002.

Several months ago, the Taliban fired upon a survey team driving in central Afghanistan. Luckily, no one was hit. Over the past year, the project has stopped doing research in several provinces because the risk is too high.

Even without the threat of violence, Afghanistan's conservative culture presents challenges for researchers. In many areas, women are not allowed to speak to men who are not relatives, so male-female teams are required. Survey materials are touchy, too.

Earlier this year, Burnham and his team planned to measure patient satisfaction by asking people to choose one of four smiley faces ranging in mood from gloomy to happy.

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