Seeing Needless Deaths Abroad, M.D. Turns Privilege Into Leverage

Robert Greenburg quit his medical practice six years ago. With it went the Newport Beach office in the shadow of Hoag Memorial Hospital Presbyterian, the six-figure income, the house on Lido Isle.

The gynecologist thought he had something more important to do.

He’d made trip after trip to Africa and fallen in love with the people and the wildlife. He was moved to tears when an elephant came close enough to touch. The people were so poor, though, and their health needs so great.

He talked to his mentor, Dr. Leo Lagasse of Cedars-Sinai Medical Center in Los Angeles. “Our only gift was medical things,” Lagasse said. “That’s all we know.”

So the two men formed Medicine for Humanity. Operating it became Greenburg’s full-time job -- that is, if something qualifies as a job when you don’t get paid. He has taken teams of doctors to developing countries throughout the world, from Malawi to Croatia to the Philippines, where they have provided training to physicians and other health workers in the treatment and prevention of cervical cancer.Greenburg has volunteers from nearly every major medical school in the country, including Harvard, Johns Hopkins, Ohio State, the University of Wisconsin, Stanford and UCLA. About 120 of the nation’s 700 gynecologic oncologists work with Medicine for Humanity, which Greenburg runs from his rented two-bedroom townhouse in Aliso Viejo.

“It’s the greatest thing I’ve ever done,” he said.

Last week, Greenburg and 10 doctors returned from seven days at the Rosebud Sioux Indian Reservation in South Dakota, where they treated 183 women.

Rosebud, a four-hour drive from the nearest major urban area, Rapid City, is one of the poorest areas in the nation. The women there are loath to travel to doctors because it puts them in an unfamiliar environment and often means going in bad weather, plus they lack child care. When Medicine for Humanity shows up, everything gets done on the spot.

“They bring some phenomenal pathology and surgical expertise,” said Dr. Timothy Ryschon, who heads the Indian Health Service hospital at Rosebud.

Medicine for Humanity has concentrated on cervical cancer because it is preventable, Greenburg said. Caused by the human papilloma virus, there is a two- to 10-year pre-cancerous state. Even if a woman has the disease, it’s highly curable.

“It’s the leading cause of cancer death in the developing world among women,” Greenburg said. “The reason it’s the leading cause of death is because there’s no screening, and if there’s no screening, there’s no treatment.”

Fatal cases of cervical cancer were also more prevalent in developed nations until the introduction of the Pap smear in the 1940s to detect abnormal cells, Greenburg said. And there was news last week that research on a vaccine for human papilloma virus had shown promise.

“Please, God, let this be the solution, but it’s a work in progress,” Greenburg said. “We’ll still have to take care of the people who have the virus.”

Medicine for Humanity depends on donations from friends, families, patients, foundations and businesses for its $100,000 annual budget. Greenburg receives no salary; he lives on savings.

“He’s living on a shoestring,” Lagasse said.

Greenburg, 57, with gray hair and beard, is often wide-eyed in wonderment as he talks. Aside from Medicine for Humanity, his passion is wildlife photography, and in his townhouse he is quick to show visitors a photo of two lions and another of three giraffes.

Greenburg had made eight trips to Africa on photo safaris before he started Medicine for Humanity. He would visit hospitals there and see women dying for lack of treatment. “That’s a horrible sight for anyone, let alone a physician, let alone a gynecologist,” he said.

“You look at it, and finally you see you’ve got to do something. It’s not like putting a man on Mars. This is fairly simple. We’ve just got to get over there.”

Deciding to devote himself full-time to the new group wasn’t difficult.

“For my whole life I wanted to be a physician, and this is being the purest form of a physician,” he said.

As for training local doctors at their destinations, the group’s physicians go on rounds with their counterparts, listen to them present cases and teach them surgical techniques.

Cancer treatment is almost nonexistent in some countries. In all of Malawi, there is one pathologist, Greenburg said. The only technician able to read Pap smears died of complications from AIDS.

Dr. William Crisp, who teaches at the University of Arizona College of Medicine, has gone on Medicine for Humanity trips to Nepal, the Philippines, Poland, Croatia and Bosnia, in addition to U.S. Navajo and Hopi Indian reservations.

The first time Crisp traveled to Cebu, deep in the Philippines, patients made 24-hour boat trips to see the doctors. One patient was a young woman whose family abused her for being unmarried and pregnant. The doctors operated and found a 40-pound tumor that would have killed her. On a usual day there, the doctors would oversee five surgeries in the morning, go on rounds with the local physicians and listen to them present cases.

Greenburg has ambitious plans for Medicine for Humanity. He is proposing programs in Malaysia, Croatia and Poland in which doctors would fly in twice a month. The biggest problem is raising the $5 million to $10 million for three- to five-year programs in each country.

He’s also trying to start a telemedicine center, so doctors could easily consult with counterparts in the developing world over the Internet. Using videoconferencing, several doctors could consult and look at a patient who is thousands of miles away.

Greenburg once thought he had his telemedicine center. The South Orange County Community College District had big plans to turn the former Tustin Marine base into a digital learning center. Lucent Technologies had agreed to give Greenburg’s group $6 million for training and the district $4 million in equipment.

Then the stock market took a dive, and, for reasons hotly disputed, the college district turned down a state grant for the learning center and scotched the project. District trustees said there were questions about the availability of the land.

“They had money, they had all these things lined up and they thumbed their nose at it,” he said.

Despite the disappointment, Greenburg pushes on.

“It’s been my dream to do this international cancer prevention work,” he said. “I practiced for 25 years. Hopefully, the next 25 years, I can do international medicine.”