The healing of Rwanda

A career conversation with Calvin Wilson, M.D.

Originally published in the January 2011 edition of the Global Health Link

By Lyndsey Crum,

Years before I began working with global health professionals I read a book by Philip Gourevitch titled, “We wish to inform you that tomorrow we will be killed with our families.”

It recounts the personal stories of the heroes and survivors of the 1994 Rwandan genocide.  It is one of my most treasured books. It reminds me of what man is capable of doing, both the good and the bad.

I mention global health alongside the book because my first exposure to the profession was meeting Cal Wilson, project director of a physician-training program in Rwanda. Little did I know at the time I read Gourevitch’s book or when I first met Cal, that I would write an account of Cal’s career and the role that he played in helping others move past the wounds of genocide and toward the healing and education of Rwanda. It is a true statement to say that Cal proves that the good done by one man is capable of healing the bad done by another.

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Since 2004 Calvin “Cal” Wilson, M.D. has served as the director of the Center for Global Health.  Earlier this year, he made a decision to step down as director and move to Rwanda indefinitely in order to provide “on the ground” oversight for a physician training program.  Before he left, I had the opportunity to speak with him about his career and the Rwandan training program.

It was Cal’s senior year of high school when he decided his career ambition was medicine.

“I had an interest in working with people,” he said. “People, rather than machines like you would in engineering.”

He recalled the decision easily, though high school was many years ago.

“I wanted to work with individuals in a way that would make a difference in their lives. And early on I knew that I had an interest in international medicine.”

After graduating high school, Cal received the Boettcher scholarship to attend Colorado College in Colorado Springs, Colo. While there he met a local nurse named Mimi. The two married following Cal’s sophomore year of college.  After the first year of marriage, they spent their anniversary working with a rural medicine missionary in Guatemala.

It was Cal’s second trip to Guatemala.  He had previously visited the missionary in order to learn the basics of rural mission medicine. His goal for the trip with Mimi was to help the missionary physician set up a local clinic laboratory.

“The doctor in Guatemala didn’t have access to a lab.  At the time I had a job in a hospital lab in Colorado Springs and my goal returning to Guatemala was to set up a small clinic lab with the doctor. So I took small centrifuge and supplies.”

Though a small effort toward improving the practice of medicine in the Guatemalan community, the trip was an indication of the distances Cal’s career would take and the impact it would create.  But the first leg of the trip started just north of Colorado Springs.

In 1969 Cal transferred from Colorado College north to the University of Colorado in order to complete his bachelor’s degree, followed by a medical degree.  After completing his M.D., Cal entered a family medicine internship at the University of Colorado Hospital in Denver, Colo. His studies position him to spend two years in the U.S. Indian Health Service before entering private practice as a partner in the Lakewood Family Medical Clinic.

After ten years in private practice Cal left the clinic to return to work in international medicine.  In 1986 he became the director of a family medicine training program in Quito, Ecuador.  The program was the first of its kind in the South American country. Though Cal eventually left the position in 1995, the program continued and has since trained 120 family physicians.  Simultaneously, Cal also directed Ecuador’s Esmeraldas River Project, a five year integrated health care and community development project along the Onzole River.

Cal’s work in Ecuador was one of many career positions overseas.  I scanned his C.V. following our conversation and many positions jumped out, especially those which Cal mentioned in passing, but were nonetheless important in shaping his career. In 2001 he consulted at an American mission hospital in Bahrain; from 1999-2004 he served as a training consultant for a USAID-funded project in Jordan; in 2005 a training consultant in El Salvador; and in 2006 was the project director for health evaluation at an Indonesian mine.

Throughout his career, Cal worked across countries and cultures, training physicians and improving the community health of the world’s developing nations.  Given his career path in creating programs, consulting and training, it appears without surprise that Cal took on the development of yet another physician training program, this time in Rwanda.

“My first visit [to Rwanda] was in 2005. I was invited by the director of medical missions at Centura Health.”

While in Rwanda the mission director took Cal to the ministry of health to meet ministry officials about a new program.

“They were starting several specialty residency programs but lacked clinical teaching professors.  What was obvious after seeing the medical system is that most of the system was provided by younger generation practitioners right out of medical school.

Cal’s observation was accurate.  According to the World Health Organization over 80% of the nation’s 432 physicians in 2004 were under the age of 50 and 32% under the age of 30. Though the age of the nation’s small workforce may have been due to older lives lost during the genocide, it was apparent to Cal that Rwanda needed help training the future health care leaders and providers.

“The Centura director contacted me for help and I felt there was a lot we could do, both in supporting the new specialty residency programs, but especially in helping the School of Medicine start a new Family Medicine program to train highly competent generalists.”

After visiting Rwanda, Cal realized the potential of assisting with the new residency programs began with his work and colleagues in Colorado. By this time Cal was the director of the University of Colorado Denver Center for Global Health and associate professor of family medicine.  He intended to leverage this role and his medical campus colleagues.

“We applied to USAID with a small proposal to bring professors to Rwanda on a visiting basis and USAID funded the project directly through their local office.”

Beginning in December 2006, the three year project at the National University of Rwanda School of Medicine paired University of Colorado medical professors with the topical training needs of the Rwandan residents in training.  Cal personally met with the school’s departments to identify their training needs. He then paired each need with a University of Colorado expert.  For three years the project brought an average of 13 visiting professors per year to Rwanda in order to train the local medical students and resident physicians.

“Last year I spent an extend period of time in a local hospital.  Our trainees are becoming the shining stars of health care delivery and the resource people for their entire hospital. There is a whole new generation of doctors being trained and they will help Rwanda.”

Creating a generation of trained physicians is critical for the country.  According to the Center for Global Health, Rwanda has only 520 practicing clinical physicians yet the population is nearly 10 million.   Unfortunately the USAID grant ended last year, requiring the program to address the issue of sustainability. But at the same time the grant ended, the U.S. Centers for Disease Control and Prevention (CDC) expressed an interest in Rwanda.  Now, in partnership with the CDC and Tulane University in New Orleans La., Cal’s team is working with the National University of Rwanda to create sustainable delivery of the training program.

“When the residency graduates its first two or three groups of well trained specialists and they begin to train new residents, then I’ll know that it is time to step out.”

Although Cal sees the need to stay present in the program for the foreseeable future, I asked him to reflect on the program so far. He told me that the longer that you spend in a part of the world, the more needs one sees.  He then told me a story about their driver last year, a genocide orphan working to support his sister, the only other survivor in his family.  One day the driver asked if he could talk with Cal.

“‘Tell me doctor, what do I have to do to become a man, I am 24 years old. I decided I should not smoke or get involved in drinking beer, or take advantage of women, is there anything more that I should do to become a man?’ asked the young driver.”

Cal thought for a moment before recalling his answer for me.

“I complemented him on his choices and then said ‘A real man is one that can control himself, just as you have decided; the only other thing to focus on is your personal integrity.’ It is not just an issue of strengthening the health system, part of the joy of being [in Rwanda] is working with individuals that need guidance on key points in their life.”

Cal’s final comment was the connection point of our conversation, the proof that he accomplished his career goal of working with individuals in a way that would make a difference in their lives.  By educating and training a new generation of physicians, many of whom are 1994 survivors, Rwanda is shedding the bandages of genocide and preparing itself for a healthy future.

“There is an incredible reward to being involved with people on an individual, personal level and helping them as best we can.”

It is an honor to know Cal and to know that his career has made a true difference to this end, for Rwanda and the many other countries in which he has worked.

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Cal and his wife Mimi left Denver after the Thanksgiving holiday, returning to Rwanda as full time support for the training program.  Although he will be missed, his name will continue to serve as a reminder of the good that can be accomplished by one man through one career.  The Center for Global Health invites you to make a difference in the lives of future physicians at home and abroad.  Please make a contribution to the Calvin L. Wilson Scholarship for Future Leaders in Global Health.  You can learn more or make your gift online at www.cufund.org.