Public Health as a Tool for Social Justice: My Interview with Mailman Professor, Dr. Leslie Roberts

After emailing back and forth for weeks, the day had arrived.  I woke up at five o’clock in the morning on this unseasonably cold day in October to meet Dr. Leslie Roberts, a professor at Mailman.  I found his biography while perusing the faculty directory and became very curious about his work in Sub-Saharan Africa.   My goal was to expand our definition of public health beyond hospitals and disease (in the traditional sense), which is the focus of our Health and Policy Management EMPH program.   After running down an atypically empty 168th Street and weaving through Bard Hall, I found a single light in a corner room in the Population and Family Health Department.  Dr. Roberts (Les) looked up from his computer and greeted me with a welcoming smile and enormous blue eyes.  For the next hour, we were lost in conversation.

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He started his career perfectly content as a high school physics teacher and cross-country coach in a small town.  Due to funding cuts in education, at the age of 22, he found himself suddenly without a job.  His brother was in a student exchange program in Kenya, so Les decided to take a leap and join him to teach physics there.  Soon thereafter, he realized that the world didn’t need more physicists. Les was completely unraveled by witnessing Kenyan women carrying water jugs on their heads over long distances without a well in sight.

Twenty-five years later, he works on documenting human rights abuses.  He came to public health because he was interested in social justice.  Now that’s a concept:  public health as a tool for social justice.

But what happened in Kenya?  What motivated the transformation? I wondered…

Back in 1984, Les was an idealistic young teacher on the brink of change.  One day, he witnessed what seemed to be an attack on an Indian woman.  (At the time, there was a coup that resulted in brutality and backlash against Ethnic Indians in East Africa.)  Les noticed the guy rip a necklace off the woman’s neck and instinctively took off after him.  After a kilometer chase through the market and down streets, Les caught up with the man and pinned him down on the roof of a car with his arm twisted behind his back.  An angry mob gathered.   Almost everyone had been robbed at some point, and they were vengeful.  As bystanders moved in to rough up the thief, Les found himself protecting the very man he chased.  Suddenly, an enormous guy arrived on the scene, asked Les what happened, and began to bash the thief repeatedly in the face.  Les tried to restrain him, but then slowly realized that this big guy was a policeman!  After more of the same in the interrogation room, where policemen were eager to get their chance at a swing, Les realized how little he knew about the culture he was now immersed in.  How to “do the right thing” became less clear.  His world was changing.

Later on the same trip, Les encountered his second path-altering experience.  He caught malaria.   With headache and fever, he was bed-ridden and miserable, barely knowing up from down. He would make frequent visits to the latrine and flop himself back into his tent in exhaustion.  He realized that this excruciating experience was commonplace for Kenyans, including children who missed much of their education because of life-threatening infections like malaria.  It was another glimpse into this incredible new world.

Why did you pick epidemiology?  I asked. 

“I didn’t,” he replied.  “Epidemiology chose me.”  After Kenya, Les went south to Tulane University in New Orleans (which was in some ways more of a culture shock than Kenya!) for a master’s degree and then to Johns Hopkins for a PhD in water engineering with a public health focus.  He was able to piece together engineering, epidemiology, and economics in his training.  While doing work with water sanitation in Peru, he became inspired to take the next step in his path for social justice and public health.  He met a couple of CDC employees who were studying cholera under the Epidemic Intelligence Service or EIS for short (just like our own classmate, Catherine Dentinger).  Since his background was not clinical, Les didn’t match immediately.  But with determination and pure tenacity, he contrived the system to get a position in the refugee health branch.  The EIS program trains officers via four main tasks: evaluation of a survey system, investigation of an outbreak, conducting an analytic analysis of a large data set, and creation of a presentation and paper on one’s work.  Interestingly, an outbreak could span from investigating a toy with a possible choking hazard to an Ebola outbreak where people are actively dying.  During his EIS training, Les was overseas 13 out of the 24 months of training.  Although many of these experiences were wonderful, others where terribly inconvenient, including a trip to Bosnia two days after his new wife moved in with him in Atlanta.  He had no idea just how impactful this trip would become…

He pauses before he proceeds. 

And then goes on to tell me that Bosnia was the first time in his life that a place actually “gave him nightmares.”  What he saw was horrific.  The Bosnians, who were being targeted by the Croats and the Serbs, commonly described horrors that seemed like hype to Les.   He couldn’t imagine that it was true – that Serbian snipers actually shot Bosnian children in the legs in order to lure adults into shooting range.   Les couldn’t believe it to be true until one day when he walked into Kosovo Hospital in Sarajevo.  Once in the ward, all he saw nothing but children in hospital beds with gunshots to the legs.  He thought of the Geneva Convention – about a room of academics discussing the issues and how a list of statistics couldn’t compare to the actual sight.  Shortly thereafter, he witnessed young boys running through an intersection, making a game out of avoiding sniper bullets and high-fiving each other after making it through alive.  

Once again, Les recalled the common thread among his experiences in water engineering, public health, and human rights, which is social justice.  Little did he know that his ultimate challenge was yet to come.

After a stint at the WHO, where Les became disheartened by the self-promotion and politics of the organization, he moved to West Virginia to enjoy the countryside with his wife while working on freelance projects and teaching.  Then, in 1999, an old EIS contact stopped by the house in West Virginia with a proposal to study water consumption in the Congo.  Wes explained to me that a common epidemiological problem stems from difficulty in quantifying the denominator.  In other words, measuring overall water production was easy, but without a population, one could not calculate water consumption per person.  And that’s what they sought out to do.

They went to the Congo.  Through surveys to understand water consumption, they stumbled upon the fact that many people were dying prematurely.  More than reported.  And further, they discovered that more than 1,400 children had died from measles within their smallish sample.  Les contacted UNICEF, the organization responsible for immunization in Eastern Congo at the time.  While waiting for UNICEF to gather vaccinations, Les conducted another survey, which revealed that immunization rates were as low as 20%.   In an unbelievable turn of events, UNICEF came back saying that they searched “all of Africa” and found no vaccines!  As expected, Les didn’t give up and proceeded to leverage his EIS contacts and through the CDC, a professor at Emory with good contacts at the WHO, they located 100,000 MMR vaccines. 

And if this story wasn’t crazy enough…

The 100,000 found vaccines were stored in a UNICEF warehouse approximately 200 kilometers south of where they were…in the Congo!  Another shocking revelation as to how these organizations work.  Les and team proceeded to arrange for vehicles and administration of the vaccines.  Within weeks, the incidence of measles cases dropped dramatically.

During our conversation, Les spoke of his many “learning points” and “game changers” throughout this path (though he didn’t use these terms and even mentioned that the phrase “tipping point” was overused). Nonetheless, another one occurred post-Congo as he collaborated with the International Rescue Committee (IRC) to publicize findings from the Congo.  A New York Times article described the war in the Congo, but severely underestimated the number of deaths. Les knew better and hoped to publish the numbers from his study in The Lancet.   He knew that the number was more like 1.5 million dead instead of the 50,000 reported in that Times article.  His contact at the IRC asked him – why publish in the Lancet when we could negotiate for a front-page article in the Times? Les was stunned!  The very idea that one could “negotiate” with the NY Times to get a cover story rocked his world.    After the story ran, Les was invited to governmental agencies like US AID, the House Subcommittee, the National Security Council, and more.  These meetings didn’t translate into immediate aid as Les had hoped due to politics and timing, but ultimately, the killings greatly decreased after Colin Powell forced negotiations that resulted in the invading troops to withdraw.

The stories continue, but my time was up.  In an hour’s time, I learned a lifetime of lessons.  And I realize that my definition and scope of public health had expanded and shifted.   At present, Dr. Leslie F. Roberts teaches classes at Mailman in the Population and Family Health Department like “Water and Sanitation in Emergencies” and “Epidemiology and Methods in Human Rights Abuses” among others.   I felt privileged to be one of his students for an hour.  We plan to invite him to the EMPH public health salon (hosted by our classmate Ellen Coleman) in early 2013 and hope you will join.

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