The Quiet Diplomat
By Molly Lyons ’97
Around the world, millions each year die from AIDS or TB, and diabetes strikes more people than ever before. Here’s what John Howe ’65 is doing to help, and why he says so much is at stake.
When we met over lunch at a restaurant in midtown Manhattan, Dr. John P. Howe III ’65 reminded me of a neurosis-less, stammerless Bob Newhart. Howe is soft-spoken and kind-mannered. In town on business, he made me promise that this article would focus more on the work of his organization and on the deep value of a life of public service than on his own merits and accomplishments, of which there are many. Because I could tell that he made this request out of genuine modesty, I am honor-bound not to write that he has won a whole host of awards with the words “distinguished” and “excellence” in their title. Or that he has the phone number of the president of China. Or that he possesses a bright and true curiosity about people and places near and far. Or that he’s had a hand in training hundreds of thousands of doctors and nurses around the world, which in turn brings essential health and happiness to countless others. Remember: you didn’t hear it from me.
Howe is president and CEO of Project HOPE (Health Opportunities for People Everywhere). The organization is the brainchild of Dr. William Walsh, a naval medical officer who, in 1958, asked President Eisenhower to turn over a U.S. Navy hospital ship to provide health education and care to the peacetime world. That ship became the SS Hope. When it set sail in 1960 from San Francisco, it carried some 250 volunteer doctors, nurses and technologists. They would not only treat patients but also teach and train local health providers so that their visit would have lasting effects. The ship was stocked with donated medications and supplies and had three operating rooms, a pharmacy, an isolation ward, a radiology department and a freshwater plant. It traveled to Indonesia, South Vietnam, Peru, Ecuador, Guinea, Nicaragua, Colombia, Sri Lanka, Tunisia, the West Indies and Brazil before docking permanently in 1974. (The Navy eventually cut up the ship for scrap.)
“Now, more than ever,” says John Howe ’65, pictured with a young patient, “medical diplomacy is not an option; it’s a must.”
By that time, Project HOPE had already started to expand its reach on land. In 1963 the program established a university teaching hospital and nursing school in Peru. In 1969 it helped to improve health care for the Latino community in Laredo, Tex., and the Navajo Reservation in Gando, Ariz. In 1974 it was the only U.S. volunteer organization to go behind the Iron Curtain to help upgrade the Polish-American Children’s Hospital in Krakow, Poland. And in 1983, China invited Project HOPE to be the first international organization to improve the country’s health care system.
Howe took the helm in the spring of 2001. Today, Project HOPE, which is based near Washington, D.C., supports efforts to train rural health providers in primary and pediatric care and in reproductive and maternal health, and to develop specialized programs in tertiary medicine, including pediatric oncology and burn care. The organization backs the construction of health care buildings. It provides medical supplies and drugs to countries in need. It also responds to disasters: Project HOPE partnered with New York City-based institutions to provide psychological support to survivors of 9/11. In the wake of Hurricane Katrina, Project HOPE sent a hospital ship to the Gulf Coast. After the 2004 tsunami, volunteers with the organization treated thousands of patients in coastal communities near the Indian Ocean.
It’s no coincidence that Project HOPE began just a few months after the Sputnik launch, when the United States was searching for ways to peacefully connect and coexist with communist countries and new political landscapes. “You may not have the same laws, say, as someone in Kazakhstan,” Howe says. “But everyone has a retina. Everyone has kidneys. And when people relate to others on that level, you begin to form a more understanding view of each other. It’s the quiet diplomacy of health care.”
Howe is familiar with quiet influences. The son of John Howe ’35 and Phyllis Howe (Class of ’38 at what is now the University of Massachusetts in Amherst), Howe grew up in a small town in western Maine. One day, riding his tricycle through his neighborhood, he met a wealthy philanthropist who summered in town. For reasons that Howe has never figured out, the doctor said to him, “I hope you’ll become a doctor.” That planted the seed. There was also Dr. William Boynton, one of two physicians in town who tended to everything from schoolyard falls to middle-of-the-night house calls. Howe admired Boynton’s “selfless devotion to caring for people—at all hours of the day and night.” Later, when Boynton went to work in public health with the U.S. Agency for International Development, Howe took note.
Howe’s father, too, shaped his son’s thinking. After Amherst, with an undergraduate degree in chemistry and an interest in forestry, the elder Howe headed product development for a timber company in Maine. At 40, he went back to school for master’s and doctorate degrees in wood chemistry. He became a professor and chairman of the wood chemistry department at the University of Idaho College of Forestry. At 65, he retired and enrolled at Andover Newton Divinity School in Massachusetts. He received a doctorate in divinity and became an ordained Presbyterian minister.
The younger Howe was in his sophomore year at Amherst when he decided to go to medical school. “I was an English major and had to run hard to fit in all the science classes in my schedule,” he says. Amherst’s president at the time was Calvin Plimpton ’39, a physician. “He would host students in his house,” Howe recalls. “In his very stately way, he was also an influence in my decision. He represented so well the life of a physician in academic leadership.” Despite what Howe calls “the pell-mell rush” to compete for a spot in medical school, Howe also found time to join the Amherst ski team (he was captain for four years) and to serve as president of his fraternity, Chi Psi.
His sophomore-year roommate, Dr. Bruce Wintroub ’65, remembers that when Howe had something to say, people listened. “He didn’t shoot from the hip,” Wintroub adds. “And he was a great listener. His receiver was bigger than his broadcaster.”
Howe attended medical school at Boston University. With its focus on fact accumulation, medical school was a change from Amherst, whose liberal arts program Howe credits with teaching him to think and express himself. In fact, he says that in his medical practice, his Amherst education was as valuable as his medical training. “There’s an art and a science of medicine,” Howe believes. “The science lies at the heart of the practice—without it, diagnoses and treatments wouldn’t be made. But the everyday practice of medicine is people-oriented.” The art, he says, involves making connections with patients and peers.
Howe completed a residency at Boston City Hospital in internal medicine, and then began a cardiology fellowship at Peter Brigham Hospital in Boston. This was during the Vietnam War, when draft rules required most medical school graduates to enter the service after their internship year. But the military allowed 15 percent of new doctors to complete their specialty training first. Howe was among that group. By the time his fellowship ended, the war was over, but he still had to fulfill his military commitment. He served for two years in the U.S. Army Medical Corps, where he headed the critical-care center in Honolulu. The center saw to the needs of military personnel and the Honolulu community, as well as to the people of the Marshall Islands.
When Howe returned to the mainland, in 1975, he was recruited to help develop the University of Massachusetts Medical School in Worcester, which was in its infancy. It was the first public medical school in the state. At the time, Massachusetts was home to only three established medical programs—at Boston University, Harvard and Tufts. Ten years later, Howe became vice chancellor and academic dean at UMass Medical School. At the same time, he served as the team physician for the Red Sox.
From there, Howe became the second president of the University of Texas Health Science Center at San Antonio, whose mission is to care for the poor. Under his leadership, the university expanded health, research and service programs in the city. It also reached out to impoverished areas in south Texas, near the Mexican border, that Project HOPE was also working to serve.
In May 2001, after 15 years at the helm in Texas, Howe joined Project HOPE in his present role. He was now at the center of a colossal effort to help some of the neediest, sickest communities around the globe.
Infectious diseases such as SARS, AIDS and tuberculosis are treatable and often preventable. With care and education, they can be stopped in their tracks. Yet they persist—and thrive. According to the World Health Organization, the 2002-03 SARS epidemic infected more than 8,000 people; of them, most lived in China, and close to 10 percent died. A study by the WHO and the Joint United Nations Programme on HIV/AIDS estimates that in 2006 alone, 2.9 million people died of AIDS-related illnesses, mostly in sub-Saharan Africa. The WHO also reports that a third of the world’s population is infected with the TB bacterium; the disease killed around 1.6 million people in 2005, mostly in Africa.
This is the landscape in which Project HOPE currently works. “The challenges of today’s troubled world are not for the faint-hearted,” Howe says. “Now, more than ever, medical diplomacy is not an option; it’s a must. The health of the world, be it medical or political, is at stake.” His organization works in 34 countries and has around 600 employees. Project HOPE has a $150-million budget, 10 percent of which comes from the government. The rest is from private donors, corporations and foundations. Howe’s job is to guide Project HOPE as it expands its reach. To that end, he spends much of his time raising money, creating new programs and recruiting and encouraging the staff.
Project HOPE works to prevent the spread of infectious diseases and to properly treat them. In an effort to combat TB, for example, HOPE has trained health care workers, held public-education campaigns and built treatment and research programs. HOPE estimates that these efforts have saved more than 46,000 lives in central Asia alone. While the hardest hit areas are thousands of miles away from the United States, TB still reaches close to home: this spring, an American took two trans-Atlantic flights while suffering from drug-resistant TB. The world is only getting smaller.
In the Hubei Province of China, Project HOPE has trained close to 9,000 health care workers and more than 14,000 community members in HIV care and prevention. The organization has also provided support and training to more than 4,000 AIDS orphans and 1,000 of their guardians in Mozambique and Namibia.
Howe has noticed, in recent years, an increased public awareness of chronic diseases, including diabetes, hypertension and stroke. Here, Project HOPE helps as well. The organization focuses heavily on women and children with programs that aim to promote healthy behaviors and to improve health care facilities and quality of care. The efforts are paying off: Rates of exclusive breastfeeding in Malawi have more than quadrupled in the four years since Project HOPE started a program in that country, according to the organization. The percentage of children vaccinated in Guatemala doubled between 2001 and 2005. And these are just two successes.
Humanitarian assistance is also at the heart of Project HOPE’s mission. “In our women’s and children’s health campaign, we operate a micro-lending program,” Howe says. “Fifty thousand women have 90 days to start small businesses and return the loan. Our default rate is only 2 percent.”
In 2005, Project HOPE helped to establish the Basrah Children’s Hospital in Iraq, and when First Lady Laura Bush spoke at a Washington, D.C., gala celebrating the hospital’s creation, she gave special praise to Howe. At Izmit Rehabilitation Center in Turkey, HOPE has trained health professionals in how to treat the physical and psychological wounds of those who survived the country’s earthquakes in 1999. HOPE has also renovated space within the surgical wing of Speransky Children’s Hospital No. 9 in Moscow for an intermediate burn care unit. By training people around the world to care for their own, and then in turn to teach their own, Project HOPE’s initial impact can last for generations. In all, HOPE has trained more than 2 million people and has distributed $1-billion worth of medicine and supplies.
Project HOPE volunteers sign up for four-week stints, though sometimes, as in the aftermath of Hurricane Katrina, they work in two-week rotations. In a way, finding volunteers is the easy part: “There’s a tremendous appetite for volunteerism among today’s doctors and nurses,” Howe says. “We provide settings for them to share their skills and talents.”
Ronda Schultz, a registered nurse, teaches nursing at the University of Texas and is a pediatric nurse at Children’s Hospital of Austin. She volunteered with Project HOPE in communities near the Indian Ocean after the 2004 tsunami. “It helped me realize why I do what I do,” Schultz says. “While you’re there, you’re constantly reminded of how blessed we are in the United States. In third-world countries, people die of stuff they shouldn’t die of. And you really understand that everybody, no matter where they live, just wants to have a nice life. They just don’t want to suffer. They may be different from us in a million ways, but they want the same things.”
Despite the far-flung locations often on Howe’s agenda, he is never far from where he started. “Last summer,” Howe says, “my wife and I went to see the family doctor who had so inspired me before he had left our small town to work in public health. I was able to tell him how much I admired his career, how he was able to meet the everyday care needs of his patients and still commit himself to worldwide health.”
Project HOPE has come full circle, too. In 1960, Walsh, the founder, wrote: “As people we reach out to other people with the wish to help them when we have little or nothing to gain from it. It astonishes and disarms the people when they see and understand our crazy personal generosity.”
In early 2005, the Navy once again sent a hospital ship for Project HOPE to staff with volunteers. The ship docked in coastal villages along the Indian Ocean, where the 2004 tsunami had left nearly 230,000 dead or missing, according to a United Nations report. The HOPE volunteers saw more than 18,700 survivors in the course of four months. After that, the PEW Global Attitudes Project found that as a result of relief efforts, nearly 80 percent of Indonesians surveyed had a more favorable view of the United States. In 2003, the study also showed, 15 percent of Indonesians had a positive opinion of the United States; in 2005, the number was 38 percent.
The mission on which Project HOPE was founded is still in evidence. And it’s a crucial mission. On so many levels, the health of people on opposite sides of the globe should concern us. “Take the SARS epidemic, which could come from Asia to New York in a matter of hours,” Howe says. “Today, China and Africa and other places are in our back yard. And we’re in theirs. What’s their problem today is our problem tomorrow.”
Molly Lyons is a literary agent in New York City. Her last piece for Amherst was about David Friend ’77 and the photographs of 9/11.
Photos: Danuta Otfinowski; Project HOPE