Breaking Down Barriers: A Profile of Michael Rich, MD, MPH
Michael Rich, MD, MPH never had any intentions of practicing medicine in the United States. From the time he decided to become a doctor, he knew he would work abroad. As a Peace Corps volunteer in Cameroon, West Africa, Rich had just graduated from college when he had the first inkling of what would eventually become his life’s work.
“I was a teacher in Cameroon, and in the two years that I spent there, four of my students died of infectious disease. I myself was sick a number of times, and it really affected me to think that a disease like malaria, which is so simple to cure, can still prove fatal in certain parts of the world. To me, the idea that a short regimen of tablets can wipe an infection from your system over the course of a few days was really impressive. I thought to myself that if I could do anything, I’d like to come back to areas like Cameroon and help them out with healthcare.”
Rich’s commitment to helping people in places like Cameroon was so strong that he created a backup plan to becoming a physician. “Because I hadn’t gone pre-med in college, I decided to work as a carpenter for my dad while I prepared to go to medical school. I figured that if I got in, I could do international health. And if I didn’t get in, then I could go to poor countries and build.”
In 1993, Rich graduated from the University of Massachusetts Medical School in Worcester. He completed his residency at St. Vincent’s Hospital in New York City, and after a short period of time working at the Lynn Community Health Center north of Boston, he began volunteering for Doctors Without Borders, or Médecins Sans Frontières (MSF).
“At MSF I ran a tuberculosis program in Uzbekistan that followed the World Health Organization (WHO) protocol. At the time, the practice was to send anyone who failed first-line drug treatment into hospice care. I thought to myself, this just can’t be right—there has to be someone out there who is doing something about this. As it turned out, the only people who were doing something about it were Paul (Farmer) and Jim (Kim). When I came back to do my Masters in Public Health at Harvard, I made it a point to introduce myself to them.”
Since joining Partners in Health (PIH) in 2001, Rich has become one of a handful of specialists in the treatment of multi-drug resistant tuberculosis (MDR-TB). Currently, there are 2,000 MDR-TB patients under treatment at Socios en Salud, PIH and the Division of Social Medicine and Health Inequalities’ Peruvian affiliate. By comparison, the whole of the United States sees approximately 500 patients per year. To Rich, however, tuberculosis is more than a clinical specialty. Thanks to the success of PIH’s work in Haiti, Russia and Peru, tuberculosis has come to serve as a vehicle by which he and his colleagues are able to address broader issues of social justice and health inequality.
“I like to think of my area of expertise as organizing programs and delivering healthcare to poor populations. In Peru, we provide a lot of direct patient care, but we also act as a consultant to the manager of the national TB program. Helping to get them funding, and to train the doctors and nurses to be TB experts as well, is essential to the sustainability of the program. In Russia, we have similar goals and tend to divide our time between training clinicians and spending time at the sites trying to find solutions to difficult clinical cases.”
Rich’s efforts to build a TB treatment model lead him into international health policy circles as well. As a member of the WHO’s TB/HIV and Drug Resistance Unit’s working group, he is tackling the important task of writing new guidelines for the WHO on the treatment of MDR-TB.
“By taking what we’ve learned at PIH and translating it into practical policies, we’re writing an extensive, consistent manual on how to treat tuberculosis.”
But despite all of his successes, Rich’s job remains a challenging one.
“You’ll be driving through Lima and see hill after hill covered with shacks. You know they don’t have running water, and there’s only one little electrical wire for the whole region, and you wonder what is ever going to change this? Sometimes it’s overwhelming, the economic, political and social forces that are against you. You’re away from your family a lot, you’re traveling all the time, and you think to yourself, the ocean’s so big and our boat is so small—how can this ever be done?”
Fortunately, the number of people who are making global health equity a priority is increasing. Institutional affiliations, such as those between PIH, Harvard Medical School and Brigham and Women’s Hospital, draw attention to the importance of the work of Rich and his colleagues at the DSMHI.
“I’m very proud to tell people why the DSMHI was created. It was created because Brigham and Women’s Hospital cares about fighting HIV and TB-- not only in their catchment area, but also throughout the world. Most doctors I know would like to have a part in international health, but it’s difficult to make a lifetime commitment to this type of job. At the DSMHI, we’re breaking down some of the barriers that stand in the way.”
Still, the demands and personal sacrifices of international health are daunting. Michael Rich just shrugs it off.
“People ask me how I work so hard, but when I’m over there in Tomsk (Russia), it isn’t work, it’s my life. My colleagues are also my friends, and it’s an incredible privilege to feel that your work has meaning. We do make progress. We save lives and we make people’s lives better. It’s a wonderful job.”
--Rachel Knott
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