Los Angeles Times Interview : Reed Tuckson : Taking the Healing Art to Underserved Communities

Donna Mungen is a producer for the A&E; Network and a contributor to National Public Radio's "All Things Considered." Tuckson was interviewed in his office at Charles R. Drew University of Medicine

Whether or not Congress passes a universal health-insurance bill, Dr. Reed V. Tuckson will shepherd in another generation of physicians and support staff committed to providing competent health care to American's underserved communities.

As president of Charles R. Drew University of Medicine, one of the nation's four historically black medical universities--and the only one west of the Mississippi--the 43-year-old internist is dedicated to an innovative health-care philosophy that stresses a team approach between community residents and the medical profession. If he has his way and collaboration between community and doctor becomes the norm, Tuckson predicts that in the next century, the omnipotent position of physicians will diminish.

Before arriving in Los Angeles in 1991, Tuckson served for four years as public-health commissioner in his home town of Washington, D.C. A graduate of Howard University, he received his medical training at Georgetown University.

As a leader in public health, Tuckson's fiery criticism of the medical industry's neglect of the poor calls into question the moral values currently taught at the nation's medical schools. But the resistance he detects does not lessen his confidence in being able to infuse a mission of service to members of his medical parish.

Tuckson is actively involved in all phases of the operation at the King/Drew Medical complex. But it's only when discussing the next generation of healers that Tuckson's animated determination surfaces. Where others see only "gang members," Tuckson sees potential scientists, because he believes the least likely candidate to succeed can, with a little encouragement, be the best applicant.

It is this vision that Tuckson brings to the red-brick Drew Hospital Training Program located adjacent to the recently opened Century Freeway. The complex stands in stark contrast to a neighborhood of small 1940s bungalows and multiplexes plastered with cryptic graffiti, discarded mattresses, plastic doll arms and whirling scrolls of trash.

Tuckson is married and the father of four.*

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Question: Are you still confident about the passage of universal health care?

Answer: I am optimistic we will achieve the fundamental moral responsibility of a civilized society: to ensure that all citizens have the opportunity to survive free of unnecessary and preventable human diseases. Unfortunately, I had not anticipated that Americans would not rally around this human mandate and that there would be this much apathy. I view that apathy with great concern, and I think this time in American history will be harshly judged. However, the game is not over and there is still the opportunity to gather in support of this basic notion called "universal access to health care."

Q: What is your concept of universal health coverage?

A: Universal coverage means all citizens will have the opportunity to receive a basic, comprehensive set of health-care services that serves to promote their health, prevent disease, receive early diagnosis and treatment, in a cost-effective and appropriate manner, consistent with the needs for survival, free of pain, misery and suffering.

Q: Why is there so much apathy?

A: It is very difficult to engage in any serious public-policy debate involving complex issues. Americans seem to have very short attention spans, and much money has been spent on, and great professional expertise applied to, creating confusion. The other thing is there are many other issues on the agenda that seem to take precedence, such as criminal justice. While I think both issues are important, it is sad that we would make decisions about crime and seem so uninterested, relatively speaking, in whether or not our fellow citizens live or die.

Q: Do you agree with the criticism that physicians were not allowed enough input into the Administration's plan?

A: Early on, perhaps, but that mistake was quickly rectified by the White House when they invited in and solicited physicians' input. . . . I know, because I was asked. However, I am saddened that this profession of people who have taken a sacred oath to be concerned about whether or not the citizens of their society live or die would be in opposition to, and not as supportive of, realizing this goal. We have the world's finest medical system, but despite the breadth and depth of our wealth and expertise, we have failed to make even the most basic of health-care service regularly available to millions, and this disparity is a hole in the heart of this nation.

Q: Why the lack of concern within the medical community?

A: We certainly have not been taught enough about our responsibility to address this neglect. We in the profession of medicine too often reflect the values of the larger society, which celebrates narcissistic self-indulgence, as opposed to living committed lives that bring us to the most fundamental human responsibility, which is to care about the quality of the survival of your fellow citizen.

Q: Los Angeles leads the nation in deaths from gunshot wounds among young African-American males. Have we turned our backs on them?

A: The community-based infrastructure that has historically been the salvation of the African-American community was left to deteriorate for a variety of very complicated reasons. The multitude of challenges confronting some of today's youth creates the absence of the concept of a "meaningful future." Without a sense of connection to a society larger than oneself, it becomes very difficult for the health community to persuade people to initiate behaviors that are consistent with long-term survival. So, as doctors, when we try to make the fight for not smoking cigarettes--so you won't get cancer at 45 or heart disease at 50--we find our children say back that the leading cause of death in their community is homicide. So what difference does it make if we smoke cigarettes?

As we work toward trying to get more social equity and reform, I am most encouraged that the answer will happen at the community grass-roots level, which in the black community has been the church. I'm very encouraged by those church leaders who recognize that responsibility and are stepping forward.

Q: How can we help these ill-prepared urban men-children?

A: We will need some new and innovative educational experiences for these young people. . . . We regularly bring to the hospital so-called gang members, and we spend a lot of time talking to them. They have an irresistible urge to analyze the forces around them, and they are struggling--too often alone--to make sense of it all. There are geniuses walking among us and they get labeled criminals and other throw-away terms that fail to grapple with who they really are. . .

But what really concerns me is that the world economy is undergoing a rapid evolution, and there will be approximately six major industries defining global competition in the next century. These industries are all heavily based on science and math. However, when you examine the curriculum and the quality of instruction in many of our inner-city schools, it becomes clear we are producing millions of children who are completely irrelevant to the future economy of this country. The inevitable consequences are disastrous, and our children understand that the crime bill, with its heavy reliance on more prisons are simply prison cells waiting with their names etched on them.

Q: How can the medical community stem this tide?

A: The major health challenges confronting underserved communities are essentially ones that are at the heart of how life is lived. Health is the place where all the social forces converge. It is important for physicians to work in close collaboration to stimulate the resources in the community and help to develop them in a pro-active maneuver. However, there is a certain humility physicians must exhibit. We must come with a profound sense of respect for communities' abilities, capacities and opportunities to determine their own course. I want to ultimately get away from the notion that physicians are brilliant, smart people who have the answers and will dictate their prescriptions to the community.

Q: Is violence an American disease or the byproduct of neglect?

A: America has historically been--and continues to be--a very violent society, and that violence transcends class, race and gender. So many of the definitions of America--in terms of our national ego, our popular culture or our international status--are based on our capacity to exert our will on the world. These are issues America will have to grapple with in a mature way if we are going to realize our national destiny.

Q: How does this violence affect your program?

A: The heroic people who staff the King/Drew Medical Center daily confront an absolutely disgraceful human tragedy of broken and torn bodies of our children . . . The effect is not only the destruction of so many beautiful children--potential geniuses--but our energies are displaced from early diagnoses or effectively curing and managing other diseases that exist in great magnitude in South-Central Los Angeles.

The resources available to address this burden are relatively meager and inadequate, and the amount of violence-related injury presented to our hospital consumes an overwhelming amount of our resources. So, in this case, violent death becomes a contributor to many other deaths.

Q: What do you see as the mission of your graduates?

A: To be competent in their care for people who are medically underserved and to develop new knowledge in the context of that service. Also, our mission is to be concerned and smart about the survival of people who are dying at rates that are absolutely unacceptable for a civilized society. This means our students have to be twice as good as other medical students. Like everyone else, they have to know how to take care of the human organism; but they also have to understand the intimate relationship between the patient and his social environment. You see, I live by a mantra written by children from Washington, D.C., who are part of The Living Theatre Stage. And they say: "Pity and compassion in a world in pain means nothing at all unless it leads to change. We've seen enough pain, we've seen enough sorrow, but what we do with our lives must make the world better for our people tomorrow."

Q: What is unique about your faculty?

A: Our current faculty comes from all over the country and the world, and they gravitate to us, because they believe in our principles and mission. Some of our faculty grew up blocks from Drew and have dedicated their lives to serving here. Also, we are starting from the age of three months on to grow our future faculty from an unbroken continuum of science and math, through our Early Childhood Center, through our Headstart Program, through our Saturday Science Academy, through our Medical Magnet High School to our Allied Health School and, finally, to our Post Graduate Medical Training Residency Program.

Q: You finished at the top of your medical class, but you were not admitted until the first day of school, and then only after another student dropped out. What has this taught you?

A: I am left from my struggle with a profound sense of what is possible. I believe in the benefits of hard work, tenacity and attention to one's ideas. I'm completely convinced of the possibilities of being a lifelong learner. Whatever your age, never stop learning, reading or analyzing, because we only get better. To young children, my struggle says: Early on I was not the best student or destined for success, but I never gave up and the people who loved me never gave up. I didn't realize my full potential until I was 21 years of age, and I would be very sad if someone had turned off my lights, because I certainly would not have enjoyed the opportunity to contribute to this society as I have today.*

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