Practicing Patience in Healing and Giving
Dr. Scott Harrison is an orthopedic surgeon, successful entrepreneur, and visionary donor who has learned that doing philanthropy well requires patience, and a willingness to use all of life’s lessons.
In 1996, he and his wife founded CURE International, a rapidly growing nonprofit with American and British offices that oversee the building of Third World children’s hospitals. These hospitals not only treat the physically disabled, but more important they train local physicians to do the same. Currently there is a network of six hospitals that has helped over 125,000 patients and has trained numerous indigenous physicians in orthopedic techniques.
The need for this type of organization became apparent to the Harrisons during a 1986 trip to Malawi, their first to that country, to provide humanitarian medical aid. “We were shocked to learn that this country had no care, not even sub-par or minimal care.” That’s because Malawi, like many Third World nations at that time, sent its best students to First World countries to study medicine—and few returned.
“I learned in ‘86,” Harrison says, “that Malawi had sent some 110 students to First World medical schools. Only 13 returned, and just two were practicing in their native country.”
The trip showed the couple the problems associated with Third World healthcare, but it would take them ten more years to start CURE. Scott had already gained significant experience in developing networks of hospitals and managing a public for-profit company, but the two realized there were still lessons to be learned and financial resources to be secured before launching a program that could provide more than humanitarian relief.
Scott started his private practice in 1970 as a young, board-certified orthopedic surgeon. Among his first friends was a man with an interest in starting private rehab hospitals. The notion that a private hospital could succeed was a radical one in the 1970s—at the time none existed.
Nevertheless, he was persuaded to get involved, and together he and his partner launched Rehab Hospital Service Corporation in 1977. By the time the company was sold in 1983, RHSC had either built or put into the pipeline 17 hospitals. The success of this company made Harrison and his partner wealthy men.
“I don’t take credit for the financial success of the company,” says Harrison, who was mainly involved with the medical side of the business. “But I learned a lot about establishing and running a network of hospitals.”
Scott’s training in the nonprofit world was less glamorous, but no less important. In 1978, he joined the board of a small nonprofit inner-city mission in Harrisburg, Pennsylvania, that was on the verge of closing. The organization taught Scott the ins and outs of nonprofit management. In 1985, after eight years working in America, the Harrisons were ready to begin working internationally. Their motivation was personal, stemming from their Christian faith.
For the next several years, the couple made many trips to Africa to provide humanitarian medical aid. The two were energized by what they would accomplish each time, but disappointed upon their return to learn that all the work from a previous trip had been forgotten or lost.
“The needs of Third World countries are overwhelming” Scott says. Humanitarian aid, he learned, is useful and necessary. But the countries needed resident doctors and facilities if they ever expected to get medical needs under control. “Name the 100 most common diseases in the United States and Third World,” Scott says, “and they’re the same. But the incidences are very different.” Clubfeet, cleft lips and palates, and post-polio complications are rare in America, but affect millions overseas.
The couple understood what needed to happen, but in the mid-1980s weren’t sure how to get there.
In 1990, Scott received an offer to become CEO of Kirschner Medical Corporation, an international orthopedic manufacturing company. The job required him to quit his medical practice and to focus on business and the international medical community full-time. It was a big decision, and Scott was understandably hesitant.
He went ahead. It proved to be a life-altering decision. “Leaving the orthopedic practice and running an international company was the last part of the puzzle,” he says, “I couldn’t have started CURE without this experience.”
The CURE Model
CURE International describes itself as a holistic organization. Its six hospitals are located in Kenya, Uganda, Malawi, Dominican Republic, Afghanistan, and Honduras, and each places equal weight on physical healing, teaching, and spirituality.
The backbone of each hospital is the medical staff. Scott and Sally staff these facilities with both expatriate and indigenous physicians and nurses. The expatriates are there both as healers and as teachers.
Scott recruits First World surgeons who are looking to make a difference in the world with their talents. The surgeons must be strongly motivated because their salaries are modest, and the living conditions can be trying. There are a few perks, however. “We offer salaries that allow them to live a middle class existence, but also attend their kid’s soccer game. The needs are so great that paradoxically they can’t be on call all the time. We try to create a quality of life for these people.”
Scott is quick to remind them, however, that this is no easy life. For that reason, he doesn’t offer contracts to the people he recruits. If someone reaches their destination and realizes it isn’t a life they and their families can live with, they’re free to seek other opportunities.
Despite the family-friendly work hours, the need in these countries weighs heavily on everyone. According to information from the World Factbook 2002, there are some 2.8 million children in the countries that CURE is operating who are physically disabled and need medical attention.
But with great challenges come great opportunities. Scott tells Philanthropy , “If leverage is important to you as a donor, you won’t find better ways to leverage money than you will internationally. Everything can be done for less.” Especially medical work.
Part of the reason is salaries. At the CURE Children’s Hospital of Uganda, surgeons earn only about 7 percent of what a U.S. surgeon earns—nurses earn about 2 percent of U.S. nurses. Even though the salaries are considerably lower, they’re “higher than what they would normally be in their native culture,” Scott says.
Supply costs are also kept low. Many supplies are donated, which helps, but more important is the fact that Third World citizens don’t have the antibiotic immunities that Westerners do; so high-priced antibiotics aren’t required. Finally, the high-cost diagnostic equipment commonplace in the United States is not required, because diseases present themselves in such demonstrative ways. (See nearby chart of operating costs in the U.S. versus CURE’s costs in the Third World.)
The profits from the Harrisons’ business ventures permit them to fully fund the administrative and fundraising components of CURE. Last year, the Harrisons spent over $1 million of their own money to underwrite the organization. “We plan to sustain that level of funding for some time,” Scott says. “Our goal is to get to scale—20 hospitals.”
As successful as CURE is in treating Third World diseases, the group is equally successful in training indigenous surgeons. When the AIC Bethany Crippled Children’s Centre hospital was established in Kenya in 1998, the country had no orthopedic trained surgeons; today there are seven who’ve been trained by CURE staff or are in the pipeline. In Uganda, CURE pays the costs of training for about half of the orthopedic residents at the medical school in Kampala. And in Malawi, the four orthopedic surgeons that CURE has employed are the only surgeons in the country. CURE has also taken over a program in Malawi that trains people to provide primary orthopedic care after just 18 months of training. It’s something of a physician’s assistant program, and its graduates are the “backbone of orthopedic care in Malawi,” Scott says.
And the African surgeons who are trained by CURE stay in Africa, because their certification was designed so it couldn’t be easily transferred to First World nations. The whole point of CURE’s training, explains Scott, is to develop indigenous surgeons who will stay.
While the training that the nationals receive isn’t easily transferable, it’s hardly second-rate. “The quality of their training does not suffer,” Scott says. “I would argue that it’s better, because in the U.S. you’ll be trained in diseases that you see in America—you won’t be trained in what you see in the Third World, such as severe bone infections.”
Spirituality is the final component of treatment. Each hospital is equipped with a chaplain. “We believe that when health needs challenge a family, having a counselor or spiritual person there is very important,” Scott says.
Not Without Challenges
While Scott and Sally laud the impact international philanthropy can have, they also are quick to point out the difficulties associated with it. The biggest problems, according to Scott, are overcoming cultural differences. “There’s an immense difference between having a hospital in Kenya, Afghanistan, and the Caribbean.” For example, in Latin American countries, there’s a long tradition of segregating hospitals for the poor and hospitals for those who are better off. “Having a blend of patients probably can’t work in the Latin American countries,” Scott says. “It’s not going to be a problem in Africa or in Afghanistan, where the governor of the province comes to our hospital to have blood work done.”
A second problem is ensuring that what you expect will happen does in fact happen. Financial transparency is key, because perceptions of right and wrong ways to handle funds vary enormously among cultures. Scott and Sally fired a chaplain in Uganda, for example, because he lied about a small bicycle repair bill. “Perhaps this action was over the top,” Scott says, “but we wanted to send a very clear message” that financial impropriety would not be tolerated.
Perhaps the greatest challenge of all is resisting the temptation to jump too early. Despite the experience Scott had gained as a surgeon, businessman, and nonprofit leader by 1986, when the couple first saw the need for something like CURE, the two had the discipline to know the time wasn’t right. It would be another ten years before it was.
Patience in philanthropy, as in life itself, is indeed a virtue.
Martin Davis is managing editor of Philanthropy.