When conflict, crisis and disaster strike, Dr. Skip Burkle ’61 answers the world’s call
By Buff Lindau
Illustration by Jon Lezinsky
When the Bishop of Burlington, Salvatore Matano, fainted while celebrating Baccalaureate Mass on May 13 in the Ross Sports Center, Dr. Fred “Skip” Burkle ’61 was by his side before anyone even saw the doctor leave his seat. Burkle’s immediate response to a medical emergency revealed the innate devotion and training in providing quick, appropriate assistance that was being celebrated with an honorary degree at Commencement. (Burkle made sure that the Bishop was okay; he determined that Matano was dehydrated and he quickly recovered.)
A 40-year veteran professor and practitioner of emergency medicine and global public health, Burkle has worked in danger zones around the world, beginning as a highly decorated Marine physician in Vietnam. Having managed the largest bubonic plague epidemic of the 20th century in Vietnam in 1968, he was motivated to turn his career away from surgery towards public health. Over the years he has become one of the world’s top experts in global humanitarian relief medicine and policy.
“The number of professionals in the field of international health who have dealt with war and conflict issues are few,” Burkle said. It’s dangerous and not well-paid work, but “there’s something addictive about it, and you see immediately the impact of your efforts—whether clinical interventions or negotiating or bringing in supplies.” His path to expertise was lifelong and self-charted. When he first began, there was no public health specialty available to study and he had to figure out how to acquire the training necessary to pursue his interests. Today he is heartened by the increased interest in global issues amongst students at top universities.
“I feel that because of globalization and the current economic crisis, these students will refocus their work around health, education and human rights instead of economics,” he said. Indeed, he will be giving a talk at Saint Michael’s on that very subject in November 2009.
Lifelong Training
Burkle’s medical certifications, acquired with the help of the GI Bill, cover the fields of pediatrics, emergency medicine, adolescent medicine, psychiatry, tropical medicine and public health. He has spent a lifetime practicing medicine, teaching medical students at major university hospitals, devising the education for new practitioners in global health, and directing world health organizations in relief efforts around the globe.
His credentials are numerous. Now at age 69, Burkle holds faculty positions at Harvard School of Public Health; Woodrow Wilson Center for International Scholars; Monash University School of Medicine in Melbourne, Australia; School of Medicine at the University of Hawaii; Schools of Medicine and of Public Health at Johns Hopkins University; the Uniformed Services University of the Health Sciences and Tulane University School of Public Health and Tropical Medicine.
He is author of some 200 scholarly publications, referreed articles, chapters and books, and several of his most recent publications reveal some extremely pertinent concerns:
“Development of a triage protocol for critical care during an influenza pandemic,” “Iraq War Mortality Estimates” and “Counting the Dead in a decade of conflict and controversy” (articles that revealed the vast underestimation of civilian casualties in that war), “Nuclear Weapons and the Middle East” (2009), “Pandemics: State Fragility’s Most Telling Gap” forthcoming in Transition Book for the Obama Administration.
Having spent much of his professional life working in danger zones around the world has taught Burkle the range and depth of risk. But when Burkle was confronted by teenage child soldiers in Liberia, where he was a senior medical adviser for the World Health Organization in 2004, he thought he’d finally used up all of his good fortune. The experience “gave him pause.” His previous close encounters had him negotiating refugee medical assistance for the Kurds in Northern Iraq in 1992, followed by seeking humanitarian assistance for the devastated population in Somalia for CentCom (U.S. Central Command) in 1993. In 1996 Burkle assessed needs and provided guidance for the International Rescue Committee at Burmese border refugee camps, in Africa, Pakistan and the former Yugoslavia. He’d made it back from Iraq, where he was senior medical officer on the Disaster Assistance Response Team and interim minister of health in 2003, where, he says, he was the first U.S. official to have faced an assassination attempt. Perhaps the grace of God, perhaps something else, he says, helped Burkle avoid attack. But the stress, the danger, the low pay all make disaster relief medicine a career that takes its toll, he said. “If we’ve made it out alive, it’s a natural trend to devote our time to teaching those who might follow in our footsteps.”
He appears to have been called on to alleviate just about every major humanitarian crisis of the last two decades. In 1998 he served on the White House Presidential Delegation to Kosovo; in 1999, it was for relief in East Timor.
Creating a Global Health Curriculum
The crisis-managing doctor calls Hawaii his permanent home, where he and his wife of 49 years live, though he travels extensively. He and his wife, Phyllis, his high school sweetheart, are originally from Connecticut. They married when he started medical school at the University of Vermont after he graduated from Saint Michael’s in three years. They are the parents of three children.
Today Burkle regards having created a global health curriculum as his most important achievement. Humanitarian crises “come and go, and merge into a blur,” but “my greatest legacy was to essentially create the training needed to respond to these crises.” (Among other publications, his book Disaster Medicine in 1984 was the first principal text on emergency response to disasters.)
Yet everything he does to alleviate public suffering, he said, is in response to the failure of governments to provide public health protection to populations. Wars destroy the ability to protect, and it often takes a decade to provide health to a population after a war. Today, with fewer declared wars, the professor said, there are great opportunities to help prevent the renewal of war.
“If left to their own means, without international help, over 47 percent of post-conflict countries will return to war in a decade—and that’s 60 percent in Africa.” We’re too much absorbed in thinking there are military solutions for the world’s ills. But in truth it’s the public health infrastructure that will return a country to the opportunity for prosperity and peace.
“What I and others do is like pushing a rock up a hill in Hades,” he said. “You just keep pushing it up—we know we are mitigating illness and death, and we know too that it keeps some cultures alive.”
“Wars cause 15 percent of deaths in a country, while the break-down in public health, during and after conflict, causes the rest.” There were 991 deaths in New Orleans because of Hurricane Katrina in 2005, he said, but there was a 47 percent increase in deaths in the city the following year. “Resources were not put in place to protect the population.” Three years after the tsunami that ravaged southeast Asia, despite unprecedented amounts of money going to the affected countries of Sri Lanka, Indonesia, India and Thailand, they still have poor water, poor sanitation, poor health facilities, and lack of health care workers in the affected areas.
The common thread is the failure to put the resources in the right place. When politicians are making these choices, they direct efforts towards economic recovery for corporations and businesses, rather than towards the public health of the population. “Obama is now trying to rebuild the public health infrastructure” that has been so neglected in this country, Burkle said. Referencing New Orleans, he said, “Disasters keep governments honest by defining the public health and exposing its vulnerabilities.”
A Ticking Time Bomb
Burkle is focused on problems around the world that are linked to the health of the population. Constantly on his mind are mega-cities, such as Mumbai (Bombay), Kolkata (Calcutta), New Delhi, Mexico City and a number of cities in China, the Middle East and South America, all of which are growing by a million people every six months. Health and the economy have improved for some in those places, but there’s an enormous population of disaffected youth in each city “that’s worse than in the 1950s.” Now the gap between haves and have-nots has widened enormously and the have-nots are existing in squatter conditions, side-by-side with the haves in beautiful cities around the world. “Fully 78 percent of the population in mega-cities are squatters.”
We see this in the global health field as a ticking time bomb,” he said, and “it’s going to show its ugly head.” In China, for instance, now that the economy has started to deteriorate, there are some 20 million people who’ve lost their city jobs and can no longer send money back to their homes in the country. Crime, violence and rebellion are on the upswing, and what that turns into, he said, depends on the government response. In such a big country, with such a huge population, mass incidents and political upheavals are expected.
Preserving Cultural Diversity
“No one form of governance is appropriate for every country in the world,” he noted. It is essential, he added, to understand different cultures, if we want to advance the health and safety of the population, and not simply make decisions for the sake of business profit.
Burkle’s world view has been shaped by a lifetime of responding to global health emergencies. He believes the solution lies in responding appropriately to the vastly differing cultures around the world. “The World Bank,” he said, “has been focused on the idea that if you bring back the economy, everything else will follow . . . and that has been shown not to be true—you need to bring back more than the economy.”
He is convinced that preserving the worlds’ cultures is essential. Yet, because of wars of the last three decades, “we’ve moved from over 6,000 cultures to a little more than 600.” This creates a security and a strategic crisis he says, for without their sustaining cultures, countries become dysfunctional. We won’t be successful, even with health interventions, without understanding the cultures we’re trying to help.
“Managing or mismanaging the wars in Iraq and Afghanistan is related directly to our failure to understand the cultures in those countries,” he said. He resigned from his Bush Administration position as Interim Minister of Health in Iraq and “was very verbal about how little they understood the culture and the people,” and that led to unnecessary deaths among civilians and the military. The decision-makers have tremendous gaps in their knowledge and are too invested in “thinking a military direction is the solution for the world’s ills.”
Education, he said, is going to save the world. Understanding cultures through liberal education is essential. Military solutions leave countries devastated, even the countries that win. He said a professor in his UC Berkeley public health program in the early 70s said it right, when he said, “If you just educated women in the world, the death rate of children would decline rapidly.”
Champion of the Liberal Arts
Burkle was educated at Saint Michael’s and UVM Medical School, then Yale for post-doctoral work and residencies in pediatrics and emergency services; then a Harvard fellowship in adolescent medicine; Berkeley public health; Dartmouth psychiatry; University of Geneva, health emergencies in large populations; and Royal College of Surgeons, Dublin, tropical medicine.
Among his many awards are two that stand out: The Gorgas Medal, presented in 1999 by the American College of Military Surgeons for “distinguished work in preventive medicine, groundbreaking work in disaster management and humanitarian assistance and the training of an entire generation,” and his election in 2007 to the Institute of Medicine, National Academy of Sciences, for whom he is assessing Medical Preparedness for a Nuclear Event.
The consummate scientist/humanitarian, Dr. Burkle remains concerned that colleges and universities will get increasingly technical, rather than understanding that they must remain “a bastion for both that and liberal education,” because, “you cannot be a thinker in your field without having a liberal arts background,” he said. “While struggling with problems that will challenge their political, religious and economic beliefs, this generation already fully accepts the fact that they are part of a globalized society.” This will support and enhance their understanding of world issues.
A whole-hearted champion of the liberal arts, the doctor considers that to be the only route to understanding cultures, sociology, history, anthropology. We can never be successful in a country unless we understand the culture. “My pre-med program at Saint Michael’s allowed me to get into medical school, but it was the liberal arts program that formed what I did with that career.” He named his American history professor Edward Pfeifer as a key influence in his Saint Michael’s education. “I used to just watch and admire him; I wanted to be like him.”
It was Saint Michael’s, he said, that allowed me to do “an extreme make-over,” to change from a shy, dreamy high school graduate to a grown-up individual. By joining everything, working as hard as possible to get into medical school, running for offices, doing compulsory Air Force ROTC, and reading constantly to fulfill the humanities curriculum, “that we all had to take,” he began to move out of shyness and reticence, and in the end got a broad education and gained maturity. “I couldn’t have done it at a larger place.”
Reminiscing at Commencement 2009 with his classmate Senator Patrick Leahy ’61, Dr. Burkle noted, “One thing we have in common is that we know that it takes much more courage to change society for the better than it does to win a war.”
