Leading Sustainable Global Health with Robert J. Havey, MD

• Havey began college planning to become an accountant but hated his classes. After taking a biology course, he knew he wanted to study science instead. Medicine brought together his interests in science and working with people. A first-generation medical student, Havey completed all his training at Northwestern University Feinberg School of Medicine and became a clinical professor himself.

• To continue some of the values of his bedside-based training, Havey recruited Northwestern patient support to start the Global Health Initiative, an international travel program for Feinberg medical students, in 2008. Today Northwestern has a higher percentage of medical students going on global health rotations than most other medical schools in the country.

• In 2019, Havey’s initiative merged with Feinberg’s Institute for Global Health, ensuring funding and infrastructure for global health education and research programs. To date, the institute has funded hundreds of programs.

• In 2021, the Shirley and Pat Ryan family endowed the Institute for Global Health in Havey’s name, securing ongoing funding for the institute. Havey believes some of his success in institutional leadership comes from his clear dedication to the mission of sustainable global health. He and the institute emphasize working with partners to improve access to billions of people who don’t have access to modern healthcare.

• In 2022, the Ryan Family Center for Global Primary Care was established with Havey as deputy director. To Havey, sustainable global health should be built on a “pyramid system” with a strong base of primary care that can direct patients to specialty care as needed. A strong global primary care system can also reduce the burden of non-communicable diseases such as diabetes and cancer.

• According to Havey, while global health starts with skilled, passionate individuals, endowment and funding extend the lifespan of individual efforts. This is especially important for global and public health, for which fundraising can be challenging, Havey says.

• Havey offers two pieces of advice for those considering a career in global health or who are early in their career. First, at the start of your career, become an expert in your specific field or area of interest in global health. Secondly, do something you love.

[00:00:00] Rob Murphy, MD: Welcome to the Explore Global Health podcast. I'm Dr. Rob Murphy, executive director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. Across the history of global health and throughout my conversations on the show, we've worked to solve the issue of sustainability. How do we avoid Band-Aid solutions and really build two-way relationships with other countries' healthcare workers? Today I'm pleased to welcome someone who has decades of experience thinking about this question, my deputy director at the Havey Institute for Global Health, Dr. Havey himself. Bob Havey is a clinical professor of Medicine at the Feinberg School of Medicine and a longtime internal medicine physician at Northwestern Medicine. And at one time, a very long time ago, he was my resident, when we were both studying here and doing our residencies and fellowships. So welcome, Bob.

[00:01:02] Robert Havey, MD:  Thank you, Rob. Happy to be here.

[00:01:04] Rob Murphy, MD: Let's start with the earliest days of your path to medicine. What first drew you to medicine and global health in the first place?

[00:01:10] Robert Havey, MD:  I started out as an accounting major in college. There was nobody in science in my family, nobody in medicine in my family. My father was an accountant. Not knowing what the heck to do, I started out and spent a year in accounting and hated every day of it. And I had to take a required science course in biology and I had the light bulb effect immediately. For whatever crazy reason I can't explain, I was drawn to it and I just pursued a scientific path of study and that then led to medicine, which was kind of a good fit for me. I love science and I love discovery, but I didn't really want to spend a career in the lab. I wanted to be around people. So I applied to med school from there, got into Northwestern and the rest is history.

[00:01:51] Rob Murphy, MD: You're a dedicated Wildcat. You attended Northwestern University Feinberg School of Medicine for your medical degree as well as your internship and residency, and now you treat patients and teach here. What has kept you at Northwestern all these years?

[00:02:06] Robert Havey, MD:  Well, you know, I always had a healthy degree of not just humility but insecurity in terms of skill set. And I always felt that as good as any of us can be individually in our chosen field, we are even better if we are surrounded by really great talent, great people, great minds. And I just didn't feel that I would keep growing, intellectually or professionally, if I was off in a solo, strip mall, remote, practice without being surrounded by the cutting-edge experts in the field. So that really kept me here. It wasn't really a hard thing to do or a hard place to stay because it's been a great culture. I've grown through a number of roles at Northwestern as medicine has changed and as health systems have changed and as Northwestern campus itself has changed. I had a moment about 30 years ago when I came out of the hospital on a Sunday morning after I was seeing my patients and I had a boot on my car, and I thought, you know, the world is changing. I used to be able to park on the street in Chicago downtown on a Sunday morning and it's getting too crowded and they're just towing cars away. So I've seen all the changes around here over all those years.

[00:03:15] Rob Murphy, MD: We're in the same boat there. In 2008, you established the Global Health Initiative, and that entity was used to expand international travel for the Feinberg School of Medicine medical students. Now Northwestern has a higher percentage of medical students going on global health rotations than most of the other medical schools in the United States. What motivated you to start this program and get involved in training in global health?

[00:03:45] Robert Havey, MD:  Yeah, that's a great question. And the answer is a little complicated because it wasn't a lifelong strategic plan. You try to keep doing what you're good at and what you love, and I love seeing patients and I love patient relationships. And I love the classical training of medicine, which in your day and my day was very bedside-based. For the listeners here, Rob and I grew up and we're literally the last generation of physicians to have been trained before technology really became prevalent in medicine. The two of us started when there was no CAT scanner or CT scan. MRI didn't exist. Echocardiograms of the heart didn't exist. So we were trained at the bedside to take histories and diagnose disease and manage problems, as it had been done for thousands of years. And you don't forget that experience, so you really start to describe that to your younger students and younger faculty that you hire as you grow in your career. I wanted to build a model where our students were trained broadly and globally, their medical education to be more than just technology-based, machine-based, and I wanted to take advantage of the fact that I felt our patients would be a great source of support – that's where the philanthropy idea came from. And it turns out both of those things worked out. The patients have come up and supported this, and the students have benefited. It was transformative for many of them. They became better doctors. They really understood the desperate need of so many people in the world, and they carried that with them and their commitment to their profession.

[00:05:17] Rob Murphy, MD: Many people are very glad that you did that, I must say. You've sort of answered this already, but can you drill down a little deeper: Why is training so important in our field?

[00:05:28] Robert Havey, MD:  It's a funny thing. I remember being a freshman in med school and you might be a medical student, you might wear a white coat, but you know nothing. I mean, the nurses would run circles around you with what they know about medicine when you're a freshman. And you have to develop these really deep-rooted, almost Marine-like experiences and training and knowledge base to really do a good job. So if you're not trained well at the beginning, you can't catch up later. You just have to really be rigorously trained in all aspects of medicine because at the end of the day, in the healthcare system and in the healthcare team, the physician's the top of the pyramid and all the critical decisions are made by the physician. So the training's critical.

[00:06:10] Rob Murphy, MD: In 2019 the Global Health Initiative was merged with the Center for Global Health, which I founded. And we became, together, the Institute for Global Health, enabling us to grow the training programs even more, in addition to the research and publications and the list goes further. What are some of the ways the institute approaches long-term outcomes in other countries rather than temporary solutions?

[00:06:40] Robert Havey, MD:  Well, it's been a journey. When we started out as the Global Health Initiative, it was originally a student travel program, and as we gathered more and more support, we started getting involved in some of the work you were doing. I remember in the early days we thought it was a big deal that, in addition to student travel, we were funding two, just two, research projects a year. As Rob knows, and as the audience may be aware, over all these years we've funded several hundred research projects and have had hundreds of faculty participate. And it's all because the end game here is sustainability. I remember being pretty profoundly affected by a newspaper article that promoted a trip of one of the major medical centers in the country to Rwanda once a year with a surgical team to repair heart valves on patients who had had rheumatic heart disease. Now you don't see rheumatic fever in the U.S. anymore, so it was a great story in the newspaper, but Dr. Murphy would've felt the same way as me, that when you see that story and you see a hundred experts carrying massive amounts of equipment to go somewhere for 10 days and operate on literally 14 people out of the millions that needed care, 14 people, and then go back home for another year and come back. Right away, I was like, that's not sustainability. In fact, that's kind of a waste. And that just cemented our feeling that is not how you approach global health. You won't have an impact. You can't scale it. It makes for good media. It really doesn't get to the root of the problem. You need to build partnerships. You need to build sustainable systems. I remember reading at the end of that article that every year that center went there, there were about 500 people whose heart valves weren't  quite bad enough to need operations but we're gonna be so bad by the next trip, those people would be dead. And I was like, well, what are we doing here? So we've learned those lessons, and I've learned a lot of that from Rob Murphy with his great experience over the years internationally, that the Band-Aids don't help. It might make the provider feel good, but you can't just walk in and walk out and think that you fixed anything.

[00:08:42] Rob Murphy, MD: Well, you hit the nail on the head with that one. That's for sure. Let's go to 2021. That was a really remarkable year. Two years into the pandemic, the Institute for Global Health gets endowed by the Shirley and Pat Ryan family, and the endowment is in your name. It's the Havey Institute for Global Health, which brought an historic amount of funding to the institute. Can you just tell us a little bit about what drew you into the institutional leadership and how did you prepare to even support or handle the institutional-level matters, such as this funding, that you're apparently so good at. I can't believe what you've done, to have an endowed Institute and one center. I mean, that is truly incredible. We are here to stay because of you.

[00:09:30] Robert Havey, MD:  That's nice. I think the answer, like a lot of answers to complex questions into sometimes great landmarks, great achievements are usually pretty simple. And this is a pretty simple answer. I am wired to approach medicine and patient care with kind of a vocational, lifelong commitment that I'm really lucky to have never avoided and never felt bad about. In fact, I've never had a bad day in my career, like ever. And I think that came across to people like Pat and Shirley, who are incredible, very thoughtful philanthropists who are savvy at knowing what's a good thing to support. So getting it done really was based on the messaging that I was pretty careful to craft through all the years of our events and all the talks I've given. And the message is the same message that Rob Murphy gives: half the population doesn't have modern healthcare or access to modern healthcare, that systems need shoring up that we have great talent in the U.S. And we can help our partner sites. We're not doing the work for them, we're doing the work with them, so that we're providing resources. And the fact is that if you don't do the work, the world's in more trouble than it's already in. I love the line when someone anywhere is desperate, everyone everywhere is at risk. That speaks to the social stability of the world. Healthcare is not just about the humanitarian side of what we do, but there's a real return on investment if we continue to shore up the infrastructure of healthcare in these really low- and middle-income areas that otherwise would take decades to come into the modern world. And Pat and Shirley knew that. I got a telephone call from them, and they just told me they wanted to make this gift out of the blue. That's also been the secret to the success. I've never asked directly for any amount of money or any specific support. I've pitched the message, invited people to our events and hoped that they would be inspired to support this. And Pat and Shirley were. And they called me and they said they had one condition, and they said they had to name it after me. And I did push back. I felt it was inappropriate. None of this work was about me, just like none of the work that Rob has done has been about him. It's been about what we're trying to accomplish. They had two purposes on naming it after me. One, they were trying to highlight the value and importance of a primary care doctor-patient relationship and how important it is for individuals to have a trusted, healthcare partner as a journey through life. And I think they felt they had that with me and they wanted to recognize that, not because of me, but because of my profession and what I represent. And then the practical side, of Pat Ryan in particular, was that, with the Ryans supporting so many things at Northwestern, they were afraid if they named it after their family that a lot of our other supporters would get the wrong notion that we were covered. It was nailed. We didn't need any more support, and were done for perpetuity, which was never the truth. They gave us a great infrastructure so the institute will live forever, but we've got so much work to do that we need so much more support.

[00:12:26] Rob Murphy, MD: It's very difficult raising money for global health or even for public health. Most people are giving large amounts of money to institutions like our own here at Northwestern but other schools and universities, because there's some personal connection. It's few and far between to find somebody as generous as the Ryan family to support global health or to support public health. And we've got eight other centers we need to fund.

[00:12:53] Robert Havey, MD:  Well, I tell our audience that they're taking a leap of faith, number one in us and myself and Rob in our hundreds and hundreds of really dedicated faculty and staff. They are making a massive difference in the lives of millions of people that they'll never meet ever and people who live in places they'll never visit. I think it speaks to the really deep, wonderful, generous spirit of most human beings that when they hear the value of what they can do for other people, they actually stand up and they do it. They feel good about it, and we feel very responsible to steward the funds carefully and well, which we do. It's no secret that this is my 18th year doing it. I don't draw a salary. I don't get paid. I've done this just for the good of the project, just like people who donate money do it for the good of the project. And I think that's a ripple effect. People start feeling that, and it lifts up everybody's spirits that they're really all involved in a great thing. So I'm grateful to all of them for that.

[00:13:51] Rob Murphy, MD: We're very fortunate here in Chicago to be associated with so many really, truly generous people. I mean, the whole culture here is about giving back. Let's talk a little bit about your really important interest, and that is primary care. And the Ryans also support the Ryan Family Center for Global Primary Care that was established in 20 22. You're the deputy director along with our previous guest on this podcast, Dr. Lisa Hirschhorn, who is the director. Can you tell me more about the importance of the primary care center's mission in sustaining global health efforts?

[00:14:27] Robert Havey, MD:  If we're going to have an impact on global health, you need to start at the primary care level. You need to get into the countries that really don't invest a lot in their own healthcare systems and figure out how to shore up, expand, scale their own primary care systems. It's hard for folks who haven't witnessed the deficiencies in some global healthcare systems to realize that the patients have nowhere to go. They have nowhere to go to check their blood pressure, their blood sugar, to treat a routine illness like diabetes, which is increasing around the world. Typically, in a lot of countries, people go to a local hospital, they have their acute illness Band-Aided and taken care of. They go home and there's no continuity, no follow up, no primary care. So if we're going to scale global health, we need to do what we do in the U.S., which is push primary care. The other reason I was really happy that this center was endowed and is growing is because even in the U.S., with as much knowledge as we have of the value of primary care, it sometimes takes a backseat to the sexier lung transplant, heart surgeries, specialty care, cancer care, which is all great, all important. But at the end of the day, you can't have a system that's run by specialty care. It has to be a pyramid system where the base is strong and shored up by great primary care providers, physicians and non-physicians alike. Then they help navigate the patient, when appropriate, to specialty care. That's more affordable, it has greater impact. So I could go on all day about primary care, but without it, systems never flourish. And they never really make an impact on a lot of the non-communicable diseases that are spreading around the world, like blood pressure, stroke, heart attack, diabetes, pulmonary disease, even cancer, all starts with primary care.

[00:16:08] Rob Murphy, MD: The Havey Institute's Center for Global Primary Care may be one of the only centers for primary care in global health, it's not a very common entity that gets funded. Why is it so important for people to give, and especially to endow a center, a professorship or the institute for the overall growth and sustainability of our programs?

[00:16:31] Robert Havey, MD:  Giving is not easy. People have a lot of causes they can contribute to. A lot of things need funding for sure. But the reality is that you can't take for granted that an institute like ours will always be here and always be able to do the work. Because like most great organizations, they begin with not just talented but really passionate, dedicated people at the very beginning. People like you, Rob, people like our center directors, you don't know if they're going to be around forever and who's going to replace them if you don't have funding to really keep growing the work that they began. So it starts with some individuals, but it can't just stay with the individual because nobody lasts forever, but the institute can last forever and the centers can last forever and the scale of what they can do can just expand exponentially once we get endowment, because then you don't just work on expendable funds. You have a steady source of income going forth forever. I mean, it's crazy if you think about it, that a hundred years from now, this institute will still be working. Nobody listening to this will be alive, but a hundred years from now, we will be bigger, better, have bigger impact. The work will never go away. There's 8 billion people in the world. There's projected to be 10 billion in the next 30 years. There's going to be no shortage of need for healthcare and global health and partnerships around the world. It's not like a hundred years from now there'll be one country. There'll still be a lot of divisions. That's part of human nature and politics, and we're going to need our kind of institute around. And thankfully the institute itself is endowed, but we can only do so much if we don't get all 10 of our centers endowed as well, so that we really have a robust machine to continue to have such massive impact and make a big difference worldwide. We need to get more and more of that so we have this very secure infrastructure to carry us into the future.

[00:18:23] Rob Murphy, MD: I have one final question and I ask every guest on the show. What advice do you have for young people who are just now embarking on a career in global health or thinking about going into a career in global health?

[00:18:35] Robert Havey, MD:  My first advice would be get yourself really well-educated and well-trained at the very beginning of your career. Don't be in a hurry to go from A to Z. Your time will come. I mean, I didn't start this the day I came out of training. To really contribute to any field, and to contribute to global health in particular, you have to be really good at whatever your field in global health will ultimately be. Whether it's infectious disease, whether it's implementation research, whether it's the economics of global health, whether it's the science side, whether it's pathogen genomics, like one of our centers runs, you've got to be great at that. Pathogen genomics is a great example. The field of pathogen genomics, knowing the gene structure of infectious organisms, that field didn't exist 10 years ago. And yet, our director, Egon Ozer, who is incredibly talented, he can't just suddenly become an expert in global pathogen genomics if he wasn't an expert in genomics to begin with. He had to build his own infrastructure as a career and then he can be a great contributor and help the entire world. So anybody looking at a career here, go through what you have to go through early in your career just on the basic infrastructure of your knowledge base and your experience base, and then pursue it. And the only second advice is kind of commonsensical: don't go into something you don't love. People who do global health, they have this deep passion that most can't even explain, but they all love it. That's a big motivator. And you're sure to be successful at something if you love it to begin with. But it can't just be your heart. You got to put in the hard work to become great at your chosen field and have the heart for it.

[00:20:10] Rob Murphy, MD: Well, that was a great answer, Bob. I really appreciate it. And I want to thank you very much for joining me today and thank you for everything you've done for the Havey Institute for Global Health.

[00:20:22] Robert Havey, MD:  Happy to be here and looking forward to lots more years with you and I together.

[00:20:26] Rob Murphy, MD: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.