Missionary Influences: A Personal Tale

Occasional Paper No. 11 Series Editor: Kevin M. Cahill, M.D.

Missionary Influences: A Personal Tale Kevin M. Cahill, M.D. New York City June 30, 2018

Table of Contents Introduction 4 India 7 Sudan 7 New York 9 Persona 13 Conclusion 14 About the IIHA and CIHC 17 IIHA Book Series and Occasional Papers 18

Introduction During the past 25 years, the Center for International Humanitarian Cooperation (CIHC) has published 20 textbooks, many translated into other languages, and 10 Occasional Papers (OPs). They are widely used throughout the world in universities and training programs for humanitarian workers; all royalties from this book series go to scholarships for training relief workers. The OPs series allows in-depth coverage of a specific topic without the inherent delays involved in organizing a symposium, editing multi-authored chapters, and producing a book. I have worked in refugee camps and complex humanitarian crises in over 70 countries for almost 60 years and some OPs are intended to capture significant events in that history.

These short publications, several written by colleagues on topics in which I was interested, reflect the diverse building blocks on which my professional life developed; they derive their authority from personal experiences that, at least I hope, might have value to a new generation privileged to serve the most vulnerable. They also link the organizations in which I worked in an almost seamless tapestry evolving from early training programs, through military service, and the establishment, over many decades, of various academic departments to adequately address differing clinical demands and research opportunities. These entities include the Tropical Disease Center (TDC) at Lenox Hill Hospital, the Institute of International Humanitarian Affairs (IIHA) at Fordham University, a public charity, the CIHC, as well as professorships in the USA, Ireland, Latin America, Africa, and Asia.

Missionaries have had a profound effect on my life, in how I view the world, what qualities I admire most in others, what experiences I have tried to translate from isolated acts to universal approaches.

I have always learned more from humble servants in impoverished settings and among those in great need, than from the titled “authorities” of government and academia.

Most of my early missionary contacts were with men and women, motivated by religious beliefs, who tried to alleviate suffering by improving the nutrition, health and education of their far less fortunate brothers and sisters. Gradually, the range and focus of missionary activities have expanded and become increasingly professional, now with established standards and guidelines, ones that emphasize core value-based approaches to international development efforts, and make them more efficient while remaining almost palpably humane.

Previous OPs have detailed memorable individuals, academic and field professionals. This paper focuses on missionaries, and how they influenced the formal academic Institute at Fordham University in New York. This is a very human story–with sometimes humorous, sometimes tragic–vignettes of interaction with missionaries. I will cite a few individuals–out of many thousands–who had a direct and practical influence on the global courses offered by the IIHA.

India My first involvement in missionary life was in Calcutta, India in 1959. Having completed my exams in medical school ahead of schedule I was awarded a Lehman Travel Grant that enabled me to spend four months at the All India Institute of Tropical Medicine. The work day at the Institute was from 7am to 1pm when the summer monsoon rains, humidity, and heat made most colleagues seek shade in those pre-air conditioning days. Being young and indefatigable I began to volunteer in the afternoons with a group of nuns caring for the dying in the dirty gutters of the city. If one were to have an introduction to the missionary way of life this was a Master Class, taught by a then-unknown Albanian nun who the world later knew as Mother Teresa. One witnessed the essential union established between those offering care, with overt love, to those dying in rags, but comforted that some help was available to ease their pain. There were no textbooks or classroom lessons on this missionary approach, but memorable, practical, shared experiences that remain as vivid to me today as when I first observed them in those fetid streets.

There was no proselytizing in the gutter, no religious instruction, but clearly a universal spiritual lesson was being taught. There was a lovely mixture of modesty and humility coupled with a fierce determination to offer assistance to those abandoned by society.

The Sisters had an almost unquestioning belief that they could make a difference for those facing imminent death. This initial exposure to utterly different goals, and motivations, and ways of leadership, provided a unique perspective influencing how I would address many of the challenges that were to be my lot in handling complex humanitarian crisis over the next sixty years.

Sudan Several years after leaving Calcutta I was in the South Sudan, investigating a parasitic disease, leishmaniasis, as the Director of Clinical Tropical Medicine for the US Naval Medical Research Unit 3 (NAMRU 3). What might have been merely an interesting laboratory-oriented journey collecting specimens for analysis at our main base in Cairo, Egypt, rapidly changed when all foreign mission

aries, of all denominations, were expelled by the Arab leaders in Khartoum for allegedly aiding the black separatist movement in the South. The missionaries provided a very significant portion of the medical care in an area larger than Kenya, twice the size of France, and, for an American perspective, one and a half times larger than California. There was also concurrent armed conflict between local tribes–the Dinka, Nuer, Shilluk–and chaos quickly prevailed. As one of the few clinicians in the area I faced responsibilities that at first seemed overwhelming.

There were no courses in medical school that prepared one in trying to provide a basic medical service with few resources and even fewer assistants. I began a daily routine of hard work, providing emergency care whenever possible, delivering babies, suturing wounds, diagnosing and treating a wide range of tropical infections and learning how to manage large scale disasters without “burning out”, or losing compassion and pride in our ancient medical traditions. But what I was creating–often with stumbling efforts – was utterly different from what was expected from my Western training and background.

One worked with “indigenous healers” and become grateful for the support of “witch doctors” who had, with ashes and bones and prayers, the trust of the community. I became their partner and they accepted my methods because I offered obvious help. I was not there to criticize or embarrass; I fully appreciated that they would stay when I departed. After four months, I left with enormous respect for the missionaries who had given their lives in these remote areas, sustained by a faith and determination that was awe inspiring.

Before the various Christian missionaries were expelled, I had become friendly with the Protestant minister and his family at the American Clinic of Dolib Hill on the Sobat River, and with Catholic clergy in Malakal and Fashoda. With a sense of history instilled in my Jesuit training at Fordham University, I recalled that Teddy Roosevelt recuperated at Dolib Hill on his African journey after leaving the White House, and that the English Lord Kitchener and the French Colonel Marchand basically divided the continent of Africa, drawing

the borders for the Sudan and North Africa, in the tiny Nile River village of Fashoda. There was a bit of poetry in these places even during the destruction of war. As a final gift from the Mill Hill Catholic mission I received their library before it was abandoned to certain looting; dozens of rare volumes, including a full set of Sudan Notes and Records, bound in crocodile skin, are now in my apartment in New York.

There is an old adage that “no good deed goes unpunished”; the temptations to criticize flourished in the military bureaucracy, and several colleagues, far from the scene, and with little knowledge of the conditions on the ground in South Sudan, felt I violated their concept of a Hippocratic Oath by my going to sleep every night with strict instructions not to awaken me until dawn. To this day my first lecture to those who now work in humanitarian crises remains, that “you do no good for anyone if you fall ill; preserving your own health is not a selfish act but the only way to provide care in the midst of chaos.” That lesson, gained during my time in South Sudan, has been fundamental to me, and to the thousands of students I have taught, who struggle to provide care now in the new troubled zones of our world.

New York Having completed my Navy tour of duty I returned to New York, teaching microbiology at New York Medical College, and beginning a clinical practice in tropical medicine. Once again, missionaries became a major focus. In those years–in the mid 1960s–most American missionaries gave their lives in overseas situations with return trips to the States every 8–10 years. Since they were away for long periods few had health insurance and many quickly discovered that one of the policies that I inherited from my physician father was a belief that clergy were to receive gratis care, if necessary; in fact, it was almost always necessary at that time. Fortunately, my office on Fifth Avenue was subsidized by a medical school mentor–a kindly Jewish physician–who felt it wonderful that his waiting room was always filled with nuns in medieval habits, and priests in cassocks and Roman collars.

The number of missionaries grew so rapidly that, by the second year, it became clear that an alternative organizational arrangement had to be secured. A local Catholic hospital offered an abandoned washroom with an examining table, desk and small laboratory to house the newly formed Tropical Disease Center. However, some supplies, and a full-time secretary were obviously necessary. My wife used to say, “you can be very bold”; my solution was to directly ask Francis Cardinal Spellman of the Archdiocese of New York for assistance in the form of a $30,000 grant. He paused briefly, left his office, and returned a few minutes later, saying, “There’s nothing memorable about $30,000; I’m giving you a check for $100,000 and we should schedule an opening this coming Thursday”. (See cover photo) The next day there was a photo of the good Cardinal looking down a microscope at a malarial smear on the front page of the New York Times. As he had predicted, other grants soon allowed for a functioning clinical program that included diagnostic and preventative services as well as research projects. From the very beginning it was a non-denominational service, free of any dogmatic identity that might impinge on accepted medical mores. The patients were grateful to be treated as individuals and not merely as members of missionary organizations. The mission superiors were aware of our strict practice of confidentiality, and often expressed their gratitude for my adhering to the Hippocratic approach. Medical findings were considered personal; in any large health program there were occasions when delicate diagnoses had to be handled with the skills of a diplomat as well as those of a physician.

As the number of missionary patients increased, peaking at around 7,000 in the 1970s and 80s, and lay missionary personnel with families returned from the field with ever greater frequency than their clerical colleagues, the need for consultants in various medical and surgical specialties grew. A devoted team of volunteers was formed and their names, for most have now died, should be part of this record: Drs. Howard Kessler, William Eisenmenger, James O’Rourke, Ruth Weichsel, Hugh Barber, among others, graciously contributed their experience and time. Since all volunteers were Lenox Hill 10

Hospital physicians, the TDC formally moved there in the late 1960s, and remains a vital part of that institution.

One of the emerging problems in providing a comprehensive medical exam for female patients was a frequent reluctance by nuns to have a pelvic exam for cancer detection. This left me, as their physician, in an unenviable position of providing an inadequate service, and I finally insisted that this was an absolutely necessary test, especially since they were examined often only every five or so years. The various orders of nuns met and agreed, providing that the Pap test could be done by me, the physician they knew and trusted. And so that became an essential part of their visit to the TDC. We had several superb gynecologists on our consulting staff to recheck any patient with questionable findings.

In my private office on Fifth Avenue, where many missionaries had to be seen due to scheduling difficulties, there are only two examining rooms. My long-term secretary, Joan Durcan, soon realized that if both examination rooms had nuns in at the same time the flow of patients came to a halt. In those years, many of the nuns wore elaborate habits and Joan, with her pithy but loving Irish insight, said, “There is nothing slower than a nun getting dressed or undressed.” She devised a simple solution–nuns could use an examination room on one side of the hallway, while the non-clerical patients were sent to the other side.

Missionaries constitute a “sentinel population”, often the only American living in remote areas for long periods. If one wishes to know, for example, how the military should be prepared for service up the river in New Guinea, then studying missionaries is an ideal epidemiological exercise. Research grants were obtained for serologic surveys, and I was later able to extend these research projects to other populations from Somalia, Ethiopia and Sudan to Central America and parts of Asia. I also formed joint projects with Dr. John Frame, who provided a small clinical program in New York for Protestant missionaries. This venture helped CDC see both my domestic and overseas studies as non-denominational. Dr. Frame, as a missionary physician, elucidated the clinical picture of Lassa 11

Fever, a highly fatal infection, in Nigeria. One does not always require large university or government programs to make major discoveries–sometimes access to local clinics and a keen eye are more important. The TDC, and its successor charity, the CIHC, were the origin for dozens of lectures, chapters, books and research papers in major peer-reviewed journals.

The funding for the missionary program at the TDC has depended on annual grants by grateful patients. The donations were made to a tax-deductible office at Lenox Hill Hospital and, later, to the CIHC, a publicly registered 501(c)3 charity, for scholarships and teaching support. Once again, the donors were from all–or no–religious backgrounds.

The clinical focus of our missionary program has changed in recent years as the numbers of missionaries have declined, and as almost all now have some type of health insurance coverage allowing greater access to other hospital facilities. I still provide tropical medicine exams but my office at Lenox Hill Hospital has been turned into the Kevin M. Cahill, M.D. Exhibit Space and Study Center, where displays on the history of medicine continue our educational work. It is a state of the art facility created by Massimo Vignelli who had designed many of my books. The exhibits have ranged from Medicinal Herbs and Plants, African Passport Masks, Ayurvedic Medicine, the Golden Age of Irish Medicine, Goya and the Horrors of War and a display of photos of body decoration in remote areas of Ethiopia where painting and scarification are done as part of healing ceremonies. Major symposia on cutting edge advances in tropical medicine and infectious diseases have also been a feature of the TDC. The first national conference on AIDS, for example, was held at Lenox Hill Hospital in 1983, and the resultant book became the basis for the first U.S. Senate Hearing on this deadly epidemic; that book was translated into many languages including Japanese, Portuguese and Arabic.

Persona It is almost impossible to select a few of the many missionaries we served for special mention. Some, however led to fundamental future directions in our programs. For example, Msgr. William Kaiser, the Director of Catholic Relief Services (CRS) African section helped establish numerous programs emphasizing the importance of using donated food, surplus drugs, and avoiding time-consuming financial support grants. Working from a VW bus he managed to identify CRS centers across Africa, bringing talented local clergy for training to the US, and arranging millions of dollars in aid to promote child and maternal welfare across the continent. His assistant, Ken Hackett, eventually became the CEO of CRS and, later, the US Ambassador to the Vatican. Our training programs offered employment opportunities for many of Monsignor’s African workers; he also baptized three of my sons.

Fr. Joseph O’Hare, S.J. was a missionary in the Philippines when he first became my patient. Later, as President of Fordham University he created the space and institutional support for the IIHA. The IIHA now has over 3,000 graduates from 140 nations. It offers two Masters programs and an undergraduate Major (one of just a few in the world to do so). Fr. O’Hare remains both an inspiration for and a great supporter of the Institute.

Another memorable missionary, Fr. Aengus Finucane, CSSP, was in Biafra, Nigeria, when first we met. He was a missionary pastor during the separatist revolution against the central government; part of his mission was to assist an oppressed people. The airfield for rebel supplies was on his property. The revolution was crushed, but his ideas regarding freedom and dignity survived. He later founded Concern Worldwide, a global charity, and became a partner in many projects with our Center, and contributed a chapter in one of my books.

Finally, I cite Sr. Ita Ford, MM, who, with several other nuns, was raped and murdered in El Salvador, in a tragic embodiment of the dangers of living a saintly missionary life in an area where support for the poor and oppressed was perceived as a fatal threat by those

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in power. Her brother, Bill Ford, a college classmate, devoted the final years of his life in trying, unsuccessfully, to bring the known killers to justice. In that same country, at the University of Central America, five Jesuit priests were assassinated for teaching the lessons of Christ; four were patients of the TDC. Conclusion The OPs of the International Humanitarian Book Series have allowed me to explore specific topics that were essential components of the broader goals and activities of the CIHC/IIHA work. The most recent OP, with a major essay by Prof. Richard Falk, focused on “The Spiritual Sources of Legal Creativity” as seen in the actions of a Maryknoll missionary priest, (and dear friend), who became Foreign Minister of his country, and, later, the President of the United Nations General Assembly. The previous Occasional Paper considered the role of the university in providing legitimacy to training programs in emerging disciplines such as humanitarian training, where there were few standards and a barely acceptable vocabulary. These OPs led me to this present reflection on the role that missionary values provided as we developed global courses for a new generation of professionals who work, hopefully, ever more efficiently, in complex humanitarian crises.

As noted at the beginning of this OP, missionaries have been a constant thread in the tapestry of my life. Their willingness to serve in distant lands, to bear hardships with equanimity, to learn foreign languages and cultures, and, most importantly, to identify with new communities in “solidarity” were, and remain, inspiring qualities.

“Solidarity” is a wonderful word used in Latin America to indicate that one is willing to get down in the mud and share the life of a neighbor. Such decisions are reflections of the strong moral, ethical and spiritual values embodied in the missionaries’ shared heritage as sisters and brothers of Mother Earth. Missionaries, by necessity, must be practical, hardworking, nonjudgmental and, basically, loving persons.

These were the traits I sought for the CIHC and the IIHA in building our core team of teachers, tutors and supervisors. All those I 14

selected for leadership positions were field workers with significant experience in refugee camps, conflict zones and natural disasters.

Their academic insights were honed in the fires of reality. The curriculum for our global curses emphasizes universal values in specific lectures, as well as in the very construct of the International Diploma in Humanitarian Assistance (IDHA) program. Our candidates come from many different backgrounds but they are taught that to be effective they must work as a team, live together, with their teachers and tutors, and experience long days (and nights) of shared exercises on many topics. Today, our thousands of IDHA graduates work in crisis zones all over the world; they carry on the lessons I absorbed from so many selfless missionary guides to life.

The missionary program at the TDC at Lenox Hill Hospital was the foundation for the much broader work of the IIHA at Fordham University. Missionaries became an integral part; from the very beginning they were part of the faculty, with at least one missionary tutor on every course, providing a constant reminder of their contributions in the field. We also selected several missionaries as candidates on every course, and our alumni include numerous religious and lay volunteers from all the major mission orders–Jesuit Refugee Service, Maryknoll, Franciscan, African Society, as well as Protestant Organizations.

The primary focus of our IDHA training is to develop the necessary skills to effectively provide emergency relief in complex humanitarian crises. A missionary’s orientation offers a critical dimension in the discussions and exercises that are the foundation for our courses. Persons with a military or legal or medical background might approach problems with varying perspectives, but these differences not only foster good debate but, more importantly, better solutions. A well-thought-out intervention for most professional relief organizations in a humanitarian crisis will have an exit strategy as a critical part of the initial plan. Missionaries, however, usually have a longer-term goal, one of identifying with their adopted community, of “being with them”, rather than measuring their contributions by the amount of immediate aid offered.

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For more than a half century I have been privileged to serve missionaries as patients on an almost daily basis. Their impact was certainly not subtle. They have taught me, every day, the basic verities of life. Those lessons have been, I hope, translated into training programs that became more caring, more compassionate, as well as more effective and loving. I share these memories as part of the historical record of the TDC/CIHC and IIHA, as part of our own missionary journey in life where we strive to incorporate the sublime and eternal with the mundane and the immediate, knowing that we sometimes fail but must, with their encouragement and example, struggle on, and on, and on....

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About the IIHA and CIHC The Institute of International Humanitarian Affairs (IIHA) at Fordham University prepares current and future aid workers with the knowledge and skills needed to respond effectively in times of humanitarian crisis and disaster. Courses are offered on a global scale; we now have over 3,000 alumni from over 140 nations.

Our undergraduate program is one of the fastest growing majors at the university.

The Center for International Humanitarian Cooperation (CIHC) was founded in 1992 to promote healing and peace in countries shattered by natural disasters, armed conflicts, and ethnic violence.

The Center employs its resources and unique personal contacts to stimulate interest in humanitarian issues and to promote innovative educational programs and training models. Our extensive list of publications and regular symposia address both the basic issues and the emerging challenges of humanitarian assistance.

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IIHA Book Series The International Humanitarian Affairs Book Series, authored or edited by Kevin M. Cahill, M.D., is devoted to improving the effectiveness of humanitarian relief programs. With contributions by leading professionals, the books are practical guides to responding to the many different effects of civil strife, natural disasters, epidemics, and other crises. Books marked with an asterisk are available in French translation from Robert Laffont of Paris; books marked with a double asterisk are available in Spanish, German, Arabic, and French. All books available at www.fordhampress.com.

Preventive Diplomacy: Stopping Wars Before They Start, 1996, 2000* Basics of International Humanitarian Missions, 2003* Emergency Relief Operations, 2003* Traditions, Values, and Humanitarian Action, 2003* Human Security for All: A Tribute to Sérgio Vieira de Mello, 2004 Technology for Humanitarian Action, 2004 To Bear Witness: A Journey of Healing and Solidarity, 2005* Tropical Medicine: A Clinical Text, 7th edition, 2006 The Pulse of Humanitarian Assistance, 2007 Even in Chaos: Education in Times of Emergency, 2010 Sudan at the Brink: Self-Determination and National Unity, F.D. Deng 2010 (Foreword) Tropical Medicine: A Clinical Text, 8th edition (Jubilee Edition), 2011** More with Less: Disasters in an Era of Diminishing Resources, 2012 History and Hope: The International Humanitarian Reader, 2013 To Bear Witness: A Journey of Healing and Solidarity, 2nd expanded edition, 2013* The Open Door: Art and Foreign Policy at the RCSI, 2014 An Unfinished Tapestry, 2015 A Dream for Dublin, 2016 Milestones in Humanitarian Action, 2017

IIHA Occasional Papers Kevin M. Cahill, M.D., Abdulrahim Abby Farah, Abdirazak Haji Hussein, and David Shinn,

On the cover.

The Future of Somalia: Stateless and Tragic, 2004

Solemn Blessing of the Tropical Disease

Mark Malloch Brown, International Diploma in Humanitarian Assistance, 2004

Research Center of St. Clare’s Hospital:

Francis Deng, Sudan: From Genocidal Wars to Frontiers of Peace and Unity, 2004

Cardinal Spellman looking into a microscope

Kevin M. Cahill, M.D., The University and Humanitarian Action, 2008

in new lab. Alongside him is Dr. Kevin M. Cahill,

Kevin M. Cahill, M.D., Romance and Reality in Humanitarian Action, 2008

associate Professor of Medicine, Tropical

Kevin M. Cahill, M.D., Gaza: Destruction and Hope, 2009

Disease, New York Medical Center.

Daithi O’Ceallaigh, The Tale Towards a Treaty–A Ban on Cluster Munitions, 2010

Photo credit: Meyer Liebowitz

Kevin M. Cahill, M.D., Maharishi University Convocation, 2016

The New York Times 2/17/1966

Professor Richard A. Falk, The Spiritual Sources of Legal Creativity, 2017

Cover and booklet design: Mauro Sarri

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Institute of International Humanitarian Affairs Fordham University Canisius Hall 2546 Belmont Avenue, Bronx, NY 10458