Looking Back on a Career in Public Health

William J. Bicknell has brought his public health expertise to 62 countries, and as founder of the BU School of Public Health’s high-profile department of international health, has trained, influenced, and mentored scores of public health students. But ask him what drives his commitment to international health and he offers the simplest of explanations: “Because it’s not nice for people to hurt. And most people can hurt less.”

Throughout a distinguished career that took him from senior physician for the Peace Corps in Ethiopia to commissioner of public health in Massachusetts to founder of the BU Center for International Health, Bicknell, an SPH professor of international health and a School of Medicine professor of family medicine, has been known for his straight talk about the angst and rewards of trying to help people in developing countries hurt less.

Today, Bicknell, who has been on medical leave for a recurrence of cancer, will draw on a lifetime in public health to deliver a special lecture, Lessons Learned from a Life in Public Health, at noon in MED’s Keefer auditorium. The event is open to the public.

Bicknell, a Newton, Mass., native who came to BU in 1978 after stints in the Peace Corps and as medical director of the Job Corps, is best known at BU not only for establishing a curriculum and an international health center, but for cultivating a long-standing University partnership with the small African country of Lesotho, hard-hit by HIV/AIDS and other chronic diseases.

According to 2009 estimates, the prevalence of HIV/AIDS in Lesotho was about 24 percent—one of the highest rates in the world. Bicknell has led an effort, dubbed the Lesotho-Boston Health Alliance, to improve Lesotho’s medical capacity by establishing a family medicine residency program that helps retain physicians in the country, and by bolstering the larger health-care system.

“We’ve been trying to reverse the brain drain—to keep Lesotho doctors in Lesotho, where they’re needed,” Bicknell explains. “We had to learn how to train people there and how to keep them there. It’s a long-term, mutually beneficial arrangement.

“We never had so-called objectives,” he says. “Our goal was less pain, less suffering, and a longer life. We have gone down some blind alleys and found some clear paths—but ultimately, we’ve built trust and strong relationships. It works.”

Bicknell spoke with BU Today in advance of his lecture about the struggles and successes of his journey through public health.

BU Today: What led you to push for BU’s curriculum to include international health?

Bicknell: When I graduated from medical school in the 1960s, there was a doctor draft in the military, and I thought, I want to go to Vietnam; I want to be a surgeon. But it was four years, and that was too long. The Peace Corps was just starting, and the U.S. Public Health Service was out looking for doctors to help keep the volunteer kids alive in Africa and Asia. So I signed on. I went to Ethiopia for two years. That was really a transforming experience for me. I mean, whoa, there are incredible problems there. My primary job was caring for the volunteers, but I also worked in local hospitals, seeing all kinds of illness and suffering. It was a social and intellectual and emotional change for me. It totally hooked me on making services work for people, on improving health care systems.

After I came to BU full-time in 1980, I was made chairman of health services in the School of Public Health. I decided to start up training programs targeted specifically to people from low-income countries—15 to 45 students a year, with only a few select Americans. I recruited students from around 70 countries to come study international health. That eventually led to the creation of the Center for International Health—now the Center for Global Health & Development. By 2000, it was a going concern—120 to 150 students. Now it’s around 250. The demographics have changed—it used to be mostly mid-career people from abroad, and now it’s mostly young, idealistic students from the United States. That’s OK. My objective was to institutionalize international health on the Medical Campus. And it’s been a success.

As a health practitioner coming into a resource-poor country like Lesotho, what have been your biggest lessons?

The most basic lessons: listen. Listen some more. Ask questions. Do not open with solutions or fixed ideas. Work together to figure out what might make sense. Tell the truth, and don’t play CYA or try to look good.

On a deeper level, what lower-income countries need is far better management, less corruption (although Lesotho has very little), and to use existing resources more wisely. Figuring out how to retain skilled personnel is key. Relevant education is very important. The challenge is mostly management and thinking out of the box and questioning premises—and not being too selfish or too greedy.

My own view is that the development-assistance process in low-income countries is seriously flawed. Although transparent, it is corrupt. I don’t mean people are stealing—but there’s no requirement that you have to do any real good for those poor people. They are necessary for funding, but you don’t actually have to help them. Nor is it easy to figure out how to help. The system doesn’t reward you on outcomes or for doing good. I think we have to have an honest dialogue about those issues.

What do you think about the U.S. commitment to AIDS prevention in Africa and Asia over the past 10 to 20 years? Has enough been done?

I think it has been of questionable value—some good, but lots of bad. We’ve definitely seen the interest waning over time. It was obvious from the start of drugs being made available—and the Clinton Foundation did a huge amount of good on pricing and availability—that the richer countries could not and would not pay for needed medications and all that goes with effective service delivery. So now we turn to “country ownership” of the program, which means, oops, we are not going to pay anymore, and instead “systems strengthening’ becomes the buzzword. Easy to say—but few know how to help countries do this. In fact, systems strengthening is a good idea and is exactly what we are doing in Lesotho. But it has to be done right.

What advice would you give students who come to BU wanting to tackle the international community’s most pressing public health issues?

Sit back—there is no most pressing issue that you can just run out and tackle. Travel, try the Peace Corps, speak to SPH alums like Arden O’Donnell (SPH’02), founder of Coalition for Courage, who have done it well. Read Ruth Stark’s book How to Work in Someone Else’s Country.

Listen. Listen more. Think. Ask questions. But remember: problems are tough and there are no simple, easy, or fast solutions. Doubt anything that sounds quick and simple.

William J. Bicknell will deliver a special lecture, Lessons Learned from a Life in Public Health, today, Wednesday, May 2, at noon at the School of Medicine Keefer Auditorium, 72 E. Concord St. The event is free and open to the public.

Lisa Chedekel can be reached at chedekel@bu.edu.