Brought to you by the students of the University of Cincinnati College of Medicine
By Alex Cortez
A number of people might agree that Physician and Society 101 could just as well have been called Global Health 101. Lecture after lecture hit upon the aforementioned topic. For some, this was great and the issues concerning global health were wholeheartedly welcomed. Yet for others, simply listening to the lectures at 3x speed was enough to go crazy. I quickly noticed a trend among the global health physicians—nearly all of them were in primary care. Don’t get me wrong, I have nothing against primary care, but I was disconcerted by the absence of any specialists among those who incorporated global medicine into their careers. It seemed like it was primary care of bust if you wanted to be involved in global health.
Whether your interest is global health or not, I’m sure you have felt a similar tension already as you wonder whether you can incorporate your personal goals and passions into your specialty of interest. It doesn’t help matters either that one’s specialty greatly influences his or her lifestyle. The family medicine docs do global and community health, the surgeons come in early and stay late, and the radiologists go home at 5 o’clock to coach their kid’s sports team. But does it have to be this way? Weighed down by these lingering thoughts, I knew there had to be another way. There must be physicians who broke the mold and said no to the status quo. And so I set out to meet and learn from those doctors who have done things differently.
A few weeks later and I am waking up at 6:00am to shadow a physician who has not followed the typical path. Around 7:00am I arrive at Children’s and miraculously find my way down the halls and up the elevators to the Colorectal Center. By the time my coffee has kicked in I realize it is now 7:45am and we are in the OR about to begin our first case. The surgeon I am shadowing is Dr. Marc Levitt, a pediatric colorectal surgeon at Children’s. For the next hour he evaluates a young girl for reoperation and then explains to her father the necessary measures to be taken so that she can live a normal and healthy life. After the OR is turned over, Dr. Levitt makes an incision into the abdomen of the next patient to perform a Malone appendicostomy—a procedure decided upon so that this boy too could live a normal and healthy life. That is what Dr. Levitt does. As a pediatric colorectal surgeon he corrects numerous anorectal malformations so that children around the country can live normal and healthy lives just like their peers.
My day in the OR with Dr. Levitt is just a small peek into his typical week at Cincinnati Children’s Hospital Medical Center. He has OR on Mondays, Tuesdays and Thursdays, conference on Wednesdays and clinic on Fridays. While seemingly hectic, it is a schedule similar to many surgeons at other academic hospitals. The difference, however, is that every two months Dr. Levitt hits pause at CCHMC to travel to Africa to continue his ongoing work of addressing similar problems outside the US. These trips are what set Dr. Levitt apart. Not only is he changing lives of children in the United States, but he is also doing similar work in the lives of children across the globe.
As one of only two pediatric colorectal surgeons in the country, Dr. Levitt brings unique skills and talents to the table. It is for these skills that Dr. Levitt, then at the Women's and Children’s Hospital of Buffalo, was recruited to establish the Colorectal Center at CCHMC six years ago. The Colorectal Center prides itself on being the first and only comprehensive, multidisciplinary pediatric colorectal center in the world. With such a busy job of operating, teaching, and managing a world-class medical center, one wonders how it is possible to travel more than 5500 miles to take his work to Africa. And why? Dr. Levitt could easily invest his spare time into his work at Children’s or take an extra vacation. When I ask this question, Dr. Levitt simply replies, “I really enjoy it, but I also feel that it is part of my job description.”
Dr. Levitt has been involved in global health for nearly 15 years. After years of work as a pediatric surgeon, Dr. Levitt began to notice that the sick coming from other countries were often those who were able to “play the system.” Concerned for the children who did not have such luxury or resources, Dr. Levitt had one response: “We have to go there.”
In 2006 Dr. Levitt made his first surgical trip to Honduras with a full surgical team including medical staff and equipment. He has since made trips around the globe building relationships in Chile, Mexico, Thailand, the Philippines, Taiwan, the Netherlands, France, Israel, Italy, Greece, and Singapore. On Dr. Levitt’s regular trips every two months he travels alone to various hospitals to train surgeons and perform operations with their surgical teams. But once a year Dr. Levitt breaks routine and brings a full team of physicians, nurses and other health care workers from CCHMC. During these trips he trains Ghanaian and North African surgeons in colorectal techniques so that they themselves can begin to correct the anorectal malformations the plague children throughout their country. His primary focus in Africa has been at Korle Bu Teaching Hospital in Accra Ghana, which will soon become the West African Colorectal Center. Dr. Levitt is proud of the Ghanaian team he works with. “They have 4 surgeons who are excellent. Two have visited and trained with us in Cincinnati already and there are several very devoted nurses to this program.”
During our day together, Dr. Levitt recounted a trip to Ethiopia years ago. “The windows to the outside remained open throughout the entire the surgery and there were flies buzzing all around the surgical field.” Although relatively unfamiliar with the OR, I was dumbfounded by contrast of the picture he paints to the extremely sterile OR I saw that morning. In Ethiopia, Dr. Levitt remembers that they didn’t even have anesthesia to give the patients. In another interesting case, Dr. Levitt recalls having to undo all of another surgeon’s previous work before even beginning to address the problem for which he had opened up the patient’s abdomen.
Not to take away from Dr. Levitt’s efforts, but the acceptance and encouragement of his global work by CCHMC cannot be overlooked. Even Dr. Levitt himself admits that it is unique for a surgeon to do so much international work. Thankfully the hospital is supportive and involved because they have higher goals productivity and revenue. CCHMC takes pride in its reputation and philosophy of prioritizing the care of children both here and aboard. “My travel time is considered work and is part of the mission of the Children's Hospital. I am encouraged to go. It helps with the mission of helping children throughout the world, it encourages referrals to Cincinnati for cases that cannot be done anywhere else, and fosters teaching and research opportunities with colleagues from around the world.”
I recently read an article on global health experiences for US surgical residents. In the article, the author argues that “the next generation of surgeons, while meeting needs locally, must also take a leadership role globally—the need for international partnership has never been more important” (Ozgediz, “Surgery in Developing Countries,” Archives of Surgery 2005). Reading this quote, I can’t help but think about Dr. Levitt’s work. Surgery has been neglected in many global health efforts, but surgeons like Dr. Levitt are beginning to put an end to this. And so thinking back to my original question of whether or not the pursuit of a global health career is “primary care or bust,” I now know the answer is no. Admittedly it is no easy task, but the two can be combined—Dr. Levitt’s is living proof.
An interview with Dr. Marc Levitt - a globe-trotting surgeon.
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