What's Your Legacy Going to Be? - Dr. Henri Ford, Dean of the University of Miami Leonard M. Miller School of Medicine

SHIV GAGLANI: Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm privileged to be joined Dr. Henri Ford. Dr. Ford has been the dean of the University of Miami Leonard M. Miller School of Medicine since 2018. He's a Haitian born pediatric surgeon, who maintains close ties with his native country, returning regularly to provide medical care to its residents. Dr. Ford is motivated by a deep desire to have a positive impact on the world and drive important change.

And I'll say as a quick side note, we're privileged to be able to work with University of Miami and many of the faculty there, including Alexander Mechaber andLina Shehadeh. And as I was telling him, I grew up in Melbourne, Florida, just a couple hours north. I worked at the Miami Project to Cure Paralysis, and one of my best friends is an internist at Miami's hospital. So, with that, Dr. Ford, thanks so much for taking the time to be with us today.

DR. HENRI FORD: It's a pleasure to be here.

SHIV GAGLANI: So, you have a really impressive resume and Wikipedia profile. You went to Princeton for undergrad and Harvard Medical school. Became a pediatric surgeon. Can you tell us, besides the accolades, in your own words, how did you go about deciding to become a physician and then choosing pediatric surgery?

DR. HENRI FORD: That's really a long story, but let me give you the truncated version. I think my interest in the sciences began while growing up in Haiti. They used to have regular public health broadcasts trying to educate the people about infectious diseases, which were really rampant. And you would know infectious diseases are truly endemic to the region. So, I was always one of these curious young kids interested in those broadcasts, always looking forward to hearing them and then taking the quiz at the end of each broadcast.

So that's really how the curiosity and interest in sciences began and it just continued over the course of my elementary school, secondary school, and certainly after I moved to Brooklyn, USA, for high school. And despite some of the language difficulties I experienced, those interests never waned. And certainly, by the time I got to college, I became more convinced that the biggest way to make a difference was to go into medicine. I wrestled with the idea of law versus medicine and I recognized what drove me, by and large, was the desire to make the biggest difference in the lives of others and in my community and so I decided that med school was the way to go. And this is probably the same rationale for choosing the field of surgery because when I started to wrestle, in my third year of medical school, between going into medicine versus surgery, I recognized that, well, the surgery was very impactful.

And the surgeon, I decided, was an internist who could operate. And so, it had to be about the pursuit of excellence. Not only did you need to understand the disease and why people develop this unlikely problem, whether it's a tumor or whether it's an infection that needed surgery, but it was important to have a full command of the material and to be able to go in there and execute an operation and do it well. So, that's why I find it very challenging and very exciting at the same time, in the ability to see the instant reward when somebody gets better, because you made the correct diagnosis and you perform the correct operation and did it well and then the person recovers.

So that was very gratifying for me. Pediatric surgery was a natural extension of this desire to make the biggest difference, because I recognize that by operating on a newborn with a lethal congenital anomaly, I was potentially adding 85 to 90 years to that baby's life expectancy, which is vastly different from operating on an 80-year-old with a colon cancer, where I would be adding another five, 10 years.

Not to diminish the importance of being able to do that, but I felt that I could make an even bigger difference by operating on small infants and then I just love taking care of children. So, pediatric surgery was the natural fit. I gravitated towards it and it became quite exciting to jump out of bed at 04:30am, to run to the hospital, to take care of those kids in itself. So one of my recommendations to my fellows and my students and so forth is you just have to follow your passion because if you follow your passion, you never work a day in your life and you wake up and they're actually paying you to pursue your hobby. So, so that's really what pediatric surgery has meant to me over the course of my career. I get to make a big difference in the lives of others. I get to really see some of those kids who otherwise would be dead now, become adults and get married and have children and send me pictures. It's very gratifying.

SHIV GAGLANI: My father is a general physician, who, when working in Africa and South Africa, became a surgeon. He had to because there weren’t enough physicians. So, he had to do C-sections and ophthalmological surgeries and he spoke with the same sort of passion about surgery as you just did, about the instant gratification that comes with it.

DR. HENRI FORD: Right. That's exactly it. I really think that anyone who's engaged in global surgery recognizes that being able to operate is an extremely, extremely important tool in your armamentarium, because without that, you're limited.

SHIV GAGLANI: So can you tell us a bit more about your return to Haiti and the trips that you take there, regularity, and how you decided to start doing that? Would love to hear more about that and I'm sure you've brought over some residents and med students in the process too?

DR. HENRI FORD: Yeah, absolutely. To put it simply, "To whom much is given, much is required." Look, I found myself at the particular phase, you heard about my emphasis on service, about trying to make the biggest difference in the lives of others in my community. At a relatively early age, I found myself the chief of surgery at one of the prominent children's hospital and venues, The Children's Hospital of Pittsburgh. And you say, when this happens to you when you're barely what, 40, 41, you say, "Okay, what comes next?" Because this is something that you hoped you would achieve towards that higher stage of your career. Do you just die or what happens? And I think it was around that time that I shifted from what I'd called the pursuit of excellence to the quest for significance. And it's really about, "How do I make an even bigger difference? What's my legacy going to be?"

In one dimension, this is where I started focusing a whole lot more on mentoring and teaching and developing the next generation of outstanding pediatric surgeons and pediatric surgeon-scientists. But at the same time, I recognize that a place like Haiti needed my services. I was going back there periodically, but probably the biggest commitment came right after the Haiti earthquake. I recognized it wasn't just the about sending money. They needed my skills when bricks were falling on little children and causing a whole lot of morbidity and deaths. It wasn't just enough to send money. It was a necessity for me to go out there as a pediatric surgeon with expertise in trauma and infectious diseases. My skills were needed.

In ensuring me going back there, I recognized after two grueling weeks, I couldn't just simply abandon the country and say, "Mission accomplished. I'm satisfied. I rest my conscience." By recognizing that it's going have to be, really, a commitment for the rest of my life because the healthcare infrastructure there was just pitiful. And had there been one, a lot more lives would have been saved. A lot more people would have ended up without amputations and the extensive morbidity that we saw after the earthquake. And so to a large extent, I felt needed to help improve the healthcare infrastructure. And especially in the domains that I feel I could be impactful, which was in the training of students, residents, and Haitian surgeons to handle newborn surgical emergencies in particular, because people were dying over there from really very pedestrian types of problems that we treat routinely in the United States and for which the survival is almost a 100%. But for a baby born in Haiti with those problems, it was a death sentence, and that was very, very troubling. 

So, I started going back pretty much on a consistent basis, working with the local surgeons at Hôpital Bernard Mevs in particular, but really going to just multiple other places because I didn't want to limit myself to just one location. So whether it was a state hospital, whether it's a hospital nearby there, whether it was a children's hospital, wherever my services I felt were we needed and could make a difference. So that has been my North Star and it's been great to see some of the improvements that have been made over the course of my engagement with the Haitian people. 

At Bernard Mevs we were able to establish a pediatric residency, which has considerably improved the outcome for many of the complex kids that I ended up operating on down there. Because as you know, you operate, you take care of them, but then you leave to go back to your day job and then you call in after a few days, and that was at the very beginning, saying "How is the patient that I operated on doing?" And they say, "Oh no. The patient died." And partly it's because people were not trained to provide the optimal postoperative care.

And I'm glad to say that that doesn't happen anymore. It's a rare one that doesn't make it. And so, it's been very, very satisfying, very gratifying to see the improvement that we've been able to make in that domain. The other thing that's been particularly exciting for me, is see the fact that our Haitian surgeons now are able to address many of the surgical emergencies that used to pretty much result in dying from the very beginning and they're doing this just like pediatric surgeons or other people working at children's hospitals in the country, in the US, would manage those patients with very, very good outcomes. So even if I'm not there, they really have been doing the right operation. In fact, sometimes I come down there and I'm examining a patient and I'm saying, "Well, who did this?" And they say, "Oh yeah, we handled that." And so, I just start smiling because it's so, so gratifying.

So, that is a wonderful thing. And of course, probably the culmination of this exciting engagement was the separation of conjoined twins that we were able to successfully perform at the Hôpital Universitaire de Mirebalais. That's the hospital that Paul Farmer, perhaps the greatest humanitarian of our time, was able to build right there in the Central Plateau of Haiti. And I admire him for his vision, his commitment, his determination, to bring about meaningful change.

And because of him, we're able to do this right there, which was a first for Haiti and the Caribbean. And most importantly, to pull off such an innovative operation, defying all odds. It was just amazing. It was just amazing and to do it well, because these children are thriving. They're almost six years old now. In fact, they'll be six-year-olds in just in a couple of weeks. So very, very exciting. They're completely normal. You can't even tell.

SHIV GAGLANI: That's incredible. I'm curious, did you overlap at all with Dr. Farmer when you were at HMS or...

DR. HENRI FORD: No, actually he started after just after I graduated, but it's been great to meet him, connect with him and really befriend him. So, he's become my brother from another mother.

SHIV GAGLANI: That's great. When I was a undergrad there, I had a chance to get to know him a little and we work with the UGHC, which is the new medical school in Rwanda, set up by Partners In Health, to provide them free access to online learning. But yeah, I couldn't agree more. The public and global health aspects are very inspiring. So, switching gears, you started working in Haiti more earnestly after the earthquake which has led to an amazing annual series of trips you take to improve the infrastructure there. We’re now dealing with a once in a lifetime pandemic.  As the dean of Miami's School of Medicine, I would love to hear your own story about how the school has adjusted to COVID-19 and what do you think some of the lasting changes will be for medical education, as well as healthcare, at Miami because of COVID?

DR. HENRI FORD: Wow. That's a big one. Let me try to unpack this question the way we would handle complex critical care patients, system by system. I think first of all, this pandemic has, I guess, exposed the consequences of structural racism leading to inequities in housing, in income, education, that really underlie a lot of the health disparities that ultimately have been responsible for what we saw, which is a disproportionate number of black and brown people being affected by COVID, just in terms of infection rate, but also in terms of mortality. I think now it just opens our eyes to some of the things that we need to do to address our health disparities, on the one hand. The other practical aspect for us has been how to meet the health needs of the people from South Florida but while at the same time, treating all of the patients who have presented to us and be able to offer really parallel care.

So now, since we've been running a COVID and the non-COVID hospital at the same time in order to meet the health of our patients -- and tie into that as an academic health center -- we had to make sure that we are training the next healthcare providers, because if we shut down our training, if they have to shut down the medical school, well, we won't have enough residents next month or next June to handle the next emergency that's going to come. So, we had to be fairly nimble in order for us to deal with all of these challenges. And I'm proud of the success that we've had. We have been able to do exactly what I've talked about which is, treat COVID and non-COVID patients, and we've done it, perhaps with the lowest mortality in the State of Florida -- 15% compared to about 21% for the rest of the hospitals in the state.

We have been able to offer virtual education to our students in the first three years, then also use our simulation center, the Gordon's Skill Center, to keep them tied-in with some of the clinical skills that they need to be successful when they do get to the wards. For the students in their third and fourth years, we had to pause initially when there was an issue about having enough PPE, but we've resolved that problem. And when we had a lot of patients over the summer, just overflowing in our hospitals, we had to worry about their own safety and so forth. But there again, we were able to manage effectively and making sure that they were not going to be exposed to an unnecessarily and great number of COVID-positive patients, but at the same time, we didn't want to deny them the opportunity to learn. I mean, this pandemic is probably a once in a generation kind of event although we're seeing them come more frequently right now, but for them not to be able to learn during that period, would mean, really, a disservice for them.

So making sure they have the right PPE, making sure they are being mentored to function within the hospital setting, was crucial. And I'm just happy that we've been able to do that. We have not had to remove them from the hospital setting unlike many of the schools have had to do. So, it's just been great that our instructors, our educators and hospital administrators, have made it their priority for us to be able to keep our students and residents actively engaged as part of the health care delivery team without, without adversely impacting their own health and safety.

SHIV GAGLANI: That's wonderful. The adjustments you all have made. Obviously, Florida was not one of the banner States in terms of the overall governmental response, but to be able to be there, to help respond, is important. What are some of the lasting changes you think, long-term, that you'd like to see coming out of COVID? We've heard obviously a lot about Telemedicine being here to stay. What are some of the things you'd like to see change systemically in our healthcare system as a result of COVID?

DR. HENRI FORD: Well, our mode of delivery is going to change and I think it's going to change for the better. The issue is that, in part, it increases access, but it's also linked to some of the structural inequities that we've talked about before. We have to make sure that people who live in disenfranchised communities have the necessary technology to benefit from Telehealth, which was the case for some of our students.  During that period the students from lower income backgrounds actually did not have internet in their home so it was very hard for them to stay at home and still benefit from the online education that we were providing. Some of them had to somehow leave their apartment to come to the library, to be on campus in order for them to have access. So, addressing the structural inequities that we've talked about remains important for the overall health of disenfranchised communities. 

If you look at how we organized the offices that used to be full of individuals -- both in terms of medical education, administration and hospital administration -- they are empty because people are able to effectively work at home and they are being asked for productivity, if not even more productivity, than ever. The early 6:00 AM meetings, the 7:00 AM meetings, it's all passé now because we are able to do this from home and the attendance at those meetings is vastly improved. And the same is true even for our conferences with our students and residents. People are really able to participate and I think we've learned in a more, I guess, concise way and without disrupting their lifestyle too much. Frankly, that is a great discovery. It's one of the unexpected advantages of this pandemic. Having said that, we also recognize the importance of being able to come together. Your group dynamics don't work as well on Zoom, in Zoom Breakout rooms, as they do in real life exposure.

So, we have had to modify our approach to create opportunities. Especially for the first shift, I asked them to come together because you can solve problems better when you have a rapport with the students, but if it's all on Zoom, it's really problematic. We have to achieve that balance. The technological piece, we’ve got that and it's happening, but we cannot ever ignore the importance of the social dimension which is coming together because ultimately you are going to be treating patients and it's going to be interprofessional education. That's a critical element. Being on Zoom all the time, it's not going to be a substitute for patient content, one-on-one interacting with your peers. 

SHIV GAGLANI: Agreed. I know we're coming up on time. So I had one last question for you which is, what advice would you give to someone considering a career in healthcare today about meeting the challenges of the COVID pandemic and beyond?

DR. HENRI FORD: To me, it goes back to why we go into medicine, right? We do so because we want to make the biggest difference in the lives of others. We want to help humanity, and COVID is Exhibit A in how we can be impacted. I know that there were instances where people question the ethics of having to expose oneself to this virus. You know they're there trying to make someone else's life better but that's really the essence of what we do in medicine. And whether it was people taking care of individuals with multidrug-resistant tuberculosis or those who were at the, really, beginning of the AIDS epidemic, who were risking their own lives. That's what we do. But as long as we know we are pursuing our passion, then it becomes a non-issue. This is why I always remind everyone, as I mentioned before, find out what really excites you, find out that discipline that seems to arouse your senses and makes all the juices flow. And if you pursued that discipline, then you will never work a day in your lives. It's always going to be about how do I practice my craft more effectively? How can I be even a greater source of comfort? How can I make a bigger difference in the lives of others? And to that extent, then you're going to have a very impactful career.

SHIV GAGLANI: Those are some inspirational words to end on. So with that, Dr. Ford, I'd like to really thank you for taking the time to be with us and more importantly, for the work you do to raise a line and improve health care capacity.

DR. HENRI FORD: Why, thank you. It's been an honor to share with you.

SHIV GAGLANI: With that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line since we're all in this together. Take care.