Celebrating Cindy Haq’s contributions to UW-Madison Global Health

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Professor and physician Cindy Haq (holding child) has improved health for children across the world, including in Uganda, pictured here.

Her father was a Muslim from India/Pakistan. Her mother, a Christian from Indiana. Her childhood heroes were Jane Goodall and Albert Schweitzer. She and her husband discussed her interest in working in developing countries before they married. She spent decades improving health and well-being in places where resources were scarce and the needs were great. She inspired many students to do the same.

“Global health might be in my DNA,” says Cindy Haq, a professor of family medicine and population health sciences and godmother of global health at the University of Wisconsin-Madison. “From as early as I can remember I was living between two worlds.  My identity was formed as a citizen of the world.  I noticed that random circumstances can create either marvelous opportunities like I had or horrendous challenges that many other people face. … I got a lucky hand.”

“When I went to Uganda, one of three children died before the age of 5. Today, it’s one out of 15. I’ve been able to contribute to that. I would not have had that experience if I would not have made that first trip. (By choosing global health), I made less money, my own children got sick, but they also learned a great deal.  We reaped soul-feeding rewards.”—Cindy Haq

As she prepares to begin a new chapter of her life as chair of the Department of Family Medicine at the University of California-Irvine, Haq took time to reflect on the evolution of global health at UW-Madison. The evidence of how much difference she made in Wisconsin can be found in a resume that includes her roles as founding director of the Center for Global Health (now the Global Health Institute), founder and inaugural director of Training in Urban Medicine and Public Health (TRIUMPH) for the UW School of Medicine and Public Health, plus university, national and international awards. She helped establish family medicine residency programs in Pakistan, Uganda and Ethiopia, and practiced family medicine in Belleville, Madison and Milwaukee, Wisconsin.

Haq sought  her first global health experience as a family medicine resident, when residency program director Marc Hansen agreed she could complete her pediatric elective rotation through a child survival program in Uganda. Due to a brutal civil war resulting in a severe shortage of health professionals, the young physician who had never managed tropical diseases found herself serving as the only physician for a half-million people. After completing her residency, she joined the faculty of Dartmouth Medical School and worked with Afghan refugees in Pakistan.

Cindy Haq, fourth from left, joins students from the TRIUMPH program she founded at UW-Madison to train physicians for local underserved inner-city communities.

When she was recruited to join the Wisconsin faculty, she was told, “This is a state school and we don’t do international health work. If you want to work abroad, you can do that as a hobby and use your unpaid time off.” She negotiated a 60 percent position and pursued international health consulting on her own time.  She returned to Pakistan with support of a Fulbright award, and later took a leave of absence to work with the World Health Organization. While she was in Geneva, then UW Medical School Dean Phil Farrell asked if she would lead an international health advisory committee to establish policies and procedures for international health experiences. Many UW health sciences faculty, residents and students were working abroad, but there were no policies, principles or coordination of these activities.

The advisory committee, including members from medicine, veterinary medicine, pharmacy, nursing and international studies, would establish the Center for Global Health that Haq directed from 2005-2011 before it became the Global Health Institute (GHI). She led global health field courses to Uganda and remained a GHI Advisory Committee member as she shifted her focus to establish the TRIUMPH program in Milwaukee to recruit and train physicians to work with local, urban medically-underserved communities.

“Cindy Haq is the reason GHI exists today.”—Christopher Olsen, director, Graduate | Professional | Capstone Certificate in Global Health

“Cindy Haq is the reason GHI exists today,” says Christopher Olsen, director of the Graduate | Professional | Capstone Certificate who was also one of the first members of the international health advisory committee. “More than just administrative structures, she laid the groundwork for the cross-disciplinary global health education programs that exist at UW-Madison.”

Lori DiPrete Brown, GHI associate director for education and engagement, adds: “Cindy led (the Center for Global Health) with wisdom, humility, and a spirit of abundance.”

GHI: What you call your baptism into global health took you as a resident to Kasangati Health Center and Makerere University in Uganda.  Your husband and three of your children, then aged 9, 4 and 1, traveled with you.

CH: Fortunately, I didn’t know how dangerous it really was or otherwise we never would have gone. At the end of civil war, there were still child soldiers with machine guns, random kidnappings, every disease known to man. One in three children was dying before the age of 5. … It was really dicey, yet when I got there, there was no turning back. I could see how desperate the situation was. … That three months was life-changing for our family and me.

When we arrived at the Kasangati Health Center, the entire village, including more than 200 people were gathered to welcome us by singing, dancing and drumming. The entire village cared for us. Our children were immediately taken up by the villagers: swept out of our arms, off they went, playing, climbing mango trees, chasing pigs and chickens. Our children became children of the village. They even brought my infant daughter to the clinic for breast-feeding when they knew it was time for her to feed. It was unbelievable. They were so glad that we were there to help them, they naturally were going to help us.  We had never experienced such strong community support.

GHI: Before you left Kasangati, you developed a curriculum to train village health workers to save children’s lives. What did you learn about global health as opposed to health care?

CH: My first day at the health center, the administrator Josiah Mafigiri sat me down and said, ‘As a doctor, I know you’re trained to see patients. But you could see people here 24 hours a day, 7 days a week until you die, but you won’t touch our need. If you see patients by yourself that won’t help us much. You need to teach … because if every time you see a patient you are teaching one of my staff, you’ll leave something important behind. That will make a difference.’

(When she visited a village to introduce a new village health worker she had trained in procedures to promote child survival, treat diarrhea and other challenges, the chief asked an important question.)

‘Doctor, you are the most educated person who’s ever come to our village. We thank you very much, and we thank you for training our village health worker. … But I need to mention: Do you know we have no water?’  Everyone in the village had to walk six kilometers a day to get muddy drinking water out of a ditch. … It was shocking to me.  I hadn’t grasped that fact. I realized I could treat diarrhea and dehydration until I die, but they’ll still be coming because they don’t have access to clean water. Then I started switching it up. I started going into Kampala to find out who was in charge of water.  I made many visits to the water office and waited for officials to arrive. When we finally met, I pleaded with them to dig bore holes so the villagers would have access to potable water.

“The first lesson was I must teach. The second lesson was about public health. Health arises from the conditions of where people live, work and play. Providing medical care was just a small part of what people needed to be healthy.  This experience opened my eyes to the social determinants of health.”

GHI: In 2001, you were asked to run an advisory committee to set policies and procedures for international health experiences at UW-Madison. How did you move from policies and procedures to establishing a Center for Global Health?

CH: As we began meeting to develop policies and procedures, the committee realized something else was needed. There were (official committee) representatives, but more and more people wanted to join. Many people were pursuing international health projects, but everybody was working on their own.  Faculty, staff and residents involved in international health were isolated and delegitimized. We had all received similar messages: ‘This isn’t real work.’ It was kind of like a secret club. These people knew this work was important and were doing the work behind the scenes. It was energizing to find each other.… We finally conducted a meeting to envision the future and set the stage for what would become the Center for Global Health.

Cindy Haq joined Girma Tefera, a UW-Madison surgeon and GHI Advisory Committee member, for a twinning partnership with Addis Ababa University that expanded medical education for physicians.

GHI: What are you most proud of from your time at UW-Madison?

CH: I could point to many programs we have built and other things that we’ve done around the world that have improved the lives of people. However, for me, one of the greatest benefits is that we have provided opportunities for our students, many of whom had hardly ever left the Midwest. Our faculty and staff have provided introductions to global health for thousands of students, similar to how my first experience in Uganda opened my eyes and changed my career path.  These students have gained entirely new perspectives, a sense of their place and potential to change the world.  That’s what the university is here for.

We now have more than 500 students enrolled in the undergraduate certificate in global health and even more at the graduate and post-professional levels.  Many of our students have gone on to work at the Centers for Disease Control and Prevention, the World Health Organization and/or become global health leaders.  What will our graduates do over the course of their careers?  Who will they teach? What programs will they launch?  Our graduates are our enduring legacy.

GHI: What would you do differently?

CH: I always wish we could’ve raised $10 million or even $100 million dollars, that we could have struck gold earlier and created an endowment and more resources to work with. However, even without major external funding we built a strong foundation for global health which is  now a major part of the university.

GHI: Why is global health important for Wisconsin?

CH: The original Wisconsin Idea stated that the boundaries of the university were the boundaries of the state. However, today we know that we are not isolated. We have porous borders. Therefore we expanded the Wisconsin idea to say that UW, a world class university, is engaged with the world.

Being engaged with the world improves our own skills and capabilities. I am a better doctor in Wisconsin because of my experience in Uganda. The same way all our students with experience abroad will be better health professionals. Seeing other parts of the world changes the way you see and do things. … You learn skills to be adaptable and flexible, and to respect and honor people in their context. If you’ve never left your own culture, you might not realize how profoundly culture affects the way we do things here.

GHI: Do you have advice for students?

CH: Get going!  Seek new experiences to fuel your passion. Take careful risks but don’t be careless and throw yourself in harm’s way: A dead doctor does nobody any good. But if you wait until everything seems perfect, you may miss opportunities to learn and grow.

I tell the students that I take to Uganda, ‘If you’re not ready to be hot, thirsty and uncomfortable, don’t come on this course. These are real risks. On the other hand, the potential benefits are enormous.  You might have an adventure that could change the course of your life.’

When I went to Uganda, one of three children died before the age of 5. Today, it’s one out of 15. I’ve been able to contribute to that. I would not have had that experience if I would not have made that first trip. (By choosing global health), I made less money, my own children got sick, but they also learned a great deal.  We reaped soul-feeding rewards.

I’ll always be grateful for my colleagues, students and time in Wisconsin and priceless opportunities to learn about and contribute to global and local health initiatives.

 

By Ann Grauvogl/December 11, 2017

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