FWD:Frail and Ill, but Still Focused on Global Health

Frail and Ill, but Still Focused on Global Health



By RICHARD PÉREZ-PEÑA
Published: June 12, 2006
In the last few weeks, the tributes to Dr. Allan Rosenfield have poured in, at conferences and dinners in his honor, in speeches by Kofi Annan, Hillary Rodham Clinton, Bill Clinton — even a song dedication from Bono at a U2 concert.

"I would trade them all back if I could get rid of the diagnosis," he said.

Dr. Rosenfield, dean of the Mailman School of Public Health at Columbia University and a pioneer in the global public health field, has amyotrophic lateral sclerosis, or A.L.S., and in a rare coincidence, he also has myasthenia gravis. Both diseases affect motor nerve functions. Myasthenia is sometimes fatal; A.L.S. nearly always is, usually within a few years of diagnosis.

As he fields the honors flowing his way — most recently a dinner Wednesday and symposium Thursday at Columbia, both dedicated to his life's work — Dr. Rosenfield says it is gratifying but awkward. "They're thinking, 'Oh my God, we'd better do it now if we're ever going to do it,' " he said.

For more than four decades, he has helped shape health care around the world, especially for women and people with H.I.V. But if there is irony or pathos in being forced to tend to his own, suddenly frail health given his long professional history, he refuses to indulge in it. He shows only a physician's matter-of-factness about his condition and some humor, though he concedes that it is a grim ordeal.

"Just getting up in the morning is a chore, and I need help showering," he said. "I've had to give up skiing, tennis, a lot of things I never thought I'd give up, and at first it was hard for me to be seen in public in a wheelchair. But to my surprise, I've accepted it all pretty well."

Laughing, he adds, "What choice do I have?"

A moment later, his neurologist calls, and Dr. Rosenfield lifts the phone and asks, "Did you come up with a cure? I'd like to have it before tomorrow night, if possible."

He would rather look forward, but all the retrospectives have him looking back, as well. And what Dr. Rosenfield, 73, sees is a public health field that is radically different from the one he entered some 40 years ago — there was no AIDS and few computers back then — and yet remains in some ways very much the same.

"The great tragedy, the great challenge, is the same one I saw in Nigeria and Thailand in the 60's — that in the developing world, girls and women don't have the power to say no," he said.

He trained as an obstetrician-gynecologist — his father was one, too — so he says that from the start, it seemed only natural to see public health issues through the lens of women's health. But that perspective, now common in his field, was distinctly unconventional then.

When he first went to Asia and Africa in the 60's, for a nonprofit group called the Population Council, he saw how difficult it was to lower the birthrate in a poor country. He was among the first people in public health to press the view that along with providing reproductive health programs, raising the social status of women was equally crucial to population control and economic development.

He and his colleagues persuaded the Thai government to change its policies, making birth control readily available in rural areas through midwives, who were plentiful, unlike doctors. The birth rate in Thailand plummeted, as the economy soared.

In 1985, he co-wrote an article in The Lancet, arguing that many third-world women died in pregnancy and childbirth because programs in maternal and child health, known in the field as "MCH," did too little for mothers. Public health experts have called the article, "Where is the M in MCH?" an important call to arms, and they still cite it often.

In another article he co-wrote 16 years later, he charged that women's health was again overlooked in efforts to prevent mother-to-child transmission of H.I.V. in poor regions. That piece, in The American Journal of Public Health, was titled "Where is the M in MTCT?"

His persistent advocacy of condoms and other birth control, needle exchange and sex education has put him at odds with some religious groups and conservatives, and he has been willing to criticize and clash with governments.

But in liberal circles and within the field of public health, Dr. Rosenfield is seen as a hero, an important thinker with a knack for making alliances, promoting projects — his own or others' — and raising money.

"Allan is one of a small number of people we can say has truly improved the world, especially for women," said Thomas R. Frieden, the New York City health commissioner.

In his 20 years as dean, Dr. Rosenfield has more than doubled the size of the school of public health and broadened its work to include more laboratory research and, in particular, projects overseas. He seems to steer every conversation in an international direction; when a group of students visits him to discuss Gulf Coast relief, he urges them to learn from the tsunami in Indonesia.

As he takes a call from Mr. Annan, or a visit from a French Foreign Ministry official, and his talk caroms from drug use in Russia to condoms in South Africa, it is hard to remember that his actual title barely hints at his reach. Despite his illness, he continues to plot his school's expansion, reach out to wealthy potential patrons and lay out strategies about making AIDS drugs available in poor countries.

But watch him walk slowly, unsteadily across his modest office overlooking the Hudson in Upper Manhattan, or reach for a machine that helps him breathe, and it is hard to believe that Dr. Rosenfield still goes to work every day.

He submitted his resignation as dean last month, but he says that if he can, he will stay on through the search for a replacement, which is expected to take at least six months. And he will continue teaching.

A year ago, he could have been mistaken for a man in his 50's, routinely flying around the world to meet doctors and government officials.

Today, he can no longer fly, and he thinks he will have to stop driving soon. Walking leaves him short of breath; he has lost 25 pounds and now uses a wheelchair much of the time. He admits to worrying about being a burden on his wife, Clare, and their two grown children.

There are smaller, daily reminders. Other A.L.S. patients call to offer advice or seek it. A company that makes nutritional supplements calls to pitch a product that it claims can slow the disease.

A.L.S., also called Lou Gehrig's disease, destroys brain and spinal cells that control muscles, leading to weakness, paralysis and death. Some people last a few months, while others survive for a decade or more. Myasthenia gravis also afflicts motor nerves and causes muscle weakness.

Dr. Rosenfield is unusually old to develop A.L.S., and says he is grateful for that. "Better that it happened in my 70's than my 50's."

He takes breaks each day, lying on his office couch with a machine that pushes air into his lungs. But he is determined to work as long as he can, as hard as he can.

"There's so much to do," he said. After a moment, he added, "Work helps me not think about where this is heading."