On the Front Lines of Global Health
Faculty Profile: James (Cliff) Roberson, DNP, director, Nurse Anesthesia program
Cliff Roberson, director of Columbia’s Nurse Anesthesia program, began his career as a Spanish and ESL instructor before working as an emergency room and cardiothoracic ICU nurse for 18 years. After receiving his master’s degree in nurse anesthesia from Columbia Nursing, he worked as a volunteer for Doctors Without Borders, Health Volunteers Overseas, and International Medical Corps in Mexico, Belize, South Sudan, Palestine, Vietnam, Bhutan and Haiti. In addition, he has taught nursing and nurse anesthesia courses in Israel and Bhutan. He received his DNP from Vanderbilt University where he developed a comprehensive educational curriculum to aid anesthesia providers in Haiti better manage obstetric emergencies. Roberson is a member of the World Health Organization’s Global Initiative Essential and Emergency Surgery committee, the Health Volunteers Overseas Nurse Anesthesia steering committee, and the Global Alliance for Surgery and Anesthesia Presence.
Q: You’ve had extensive experience working on the front lines of health care in many of the world’s developing countries. What makes volunteer efforts successful when working across borders?
A: Realistic expectations about what you can accomplish through humanitarian work is crucial. Health care providers are limited by what they can do in countries ravaged by famine or war or that have high maternal mortality rates. Nurse anesthetists can often make a real difference despite these obstacles. When I provided anesthesia in South Sudan, for example, I saw many women who had been close to death just a few hours earlier curled up happily with their babies.
Flexibility is another important quality for success. I’ve had medications for missions seized at customs and I’ve arrived at foreign hospitals where the administrators had no idea who I was or that I was coming. Being able to improvise is key. Once, in the South Sudan, I was tasked with sedating a child whose fractured hand also had an infected bone. But no one in the hospital knew how to set a fracture and the infection meant he was in danger of losing his hand. I emailed American orthopedic surgeon colleagues who provided me with detailed instructions on how to do the procedure. I convinced a doctor to perform the surgery and read her the instructions while I provided anesthesia. The boy kept his hand.
Q: What are some of the typical health problems you’ve treated in the developing world?
A: Most of the diseases I saw in Haiti and South Sudan were consequences of the aftermath of natural disasters or war. In Haiti, I cared for an entire ward of patients with advanced meningitis. Massive outbreaks of the disease stemmed from poor sanitation and people displaced by the 2010 earthquake living on the streets. I had never treated patients with infectious diseases, but I left my comfort zone and learned how to do it. In South Sudan, people suffered from the effects of two brutal civil wars and ethnic conflict. All of the patients I treated languished from malnutrition. Mothers were very thin and pregnant women were often severely anemic. I cared for children covered with tuberculosis lesions. Mothers saw so many of their babies die that many protected themselves from grief by distancing themselves from their newborns. But the bond between mothers and their children perseveres despite unimaginable conditions and within days, I saw them cuddling with their babies.
Q: The latest Ebola outbreak killed more than 10,000 people, including hundreds of health workers. What lessons have been learned from the Ebola crisis that might benefit efforts to prevent or contain another epidemic in a developing nation?
A: We learned that esoteric diseases in remote parts of the world can appear in the U.S. and create huge problems. The alarm bell went unheeded for months until health care workers and people travelling to the U.S. from Africa became infected.
Doctors Without Borders and other organizations successfully leveraged previous experience in treating cholera patients to develop Ebola containment protocols. The advent of Personal Protective Gear (PPE), which has been critical to keeping health care workers safe, seems like a simple solution. We’ve also learned that traditional burial practices where mourners touch and kiss the bodies of their loved ones are Ebola “superspreaders.” Public health experts encouraged interventions like cremations to stem the spread of infection.
Q: Columbia Nursing students fulfill clinical hours in the Dominican Republic, Spain, and Cuba as well as participate in voluntary medical missions across the globe. What do they gain from these experiences that make them better health care providers?
A: In low resource environments they gain insight into the experiences of people who live without food, water, and access to health care. They see how a person in the developing world may die from appendicitis, something that is easily treatable in the United States. Doctors Without Borders calls this process témoignage. –bearing witness to the suffering of others.
Students also gain insights about health care systems in other high resource countries. Health care in the U.S. centers on patient satisfaction, but in Western Europe, physicians and health care systems are more dominant. U.S. patients are required to consent to all procedures, but French doctors, for example, under Napoleonic law, can overrule their patients’ wishes, especially in the case of children.
I’ve discovered that the human condition is universal despite language and geographical differences. Mothers love their children, family members worry about their loved ones, and patients want to be free from pain and suffering. The human drama plays out the same whether you’re in the Sudan or London. I feel motivated to do global humanitarian work because I believe that health care is a human right. For me, it’s a social justice issue.