“A 14-year-old boy came in, clearly in heart failure. We were able to deal with it acutely, but it turned out that he had rheumatic heart disease and a bad valve as a result. Here (in the U.S.) he would have received a new valve, but there was no chance to have that done there.

“For this patient, the heart issue wasn't picked up early enough, and even if he went somewhere to get a new valve, he would need anticoagulation medication. But there's nowhere to get testing where he lived, and most people on anticoagulation are tested every couple of weeks. So the question then is how can you prevent this in the first place?”

That’s Charles “Chuck” Schubert, MD, recounting a story about a patient he helped while in Malawi on one of his many trips to Africa during his long and prestigious career.

“In a case like the 14-year-old, there's only so much you can do. You know the right thing is for him to get a valve replacement, but we can't do that. The local physicians I worked with were smart. They were good. They just didn't have the resources or the number of medical staff they needed because of financial limitations.”

The crux of the issue for this patient and many like him is that he lives in an area of the world challenged by a public health system that has limited resources and therefore cannot meet the needs of the people. Schubert realized that helping to strengthen the system—through training, providing equipment and partnerships—is where they will see improvements.

“I think we are helping the local staff move things along. During my involvement over a 10-20 year period, what I saw when I was in Zambia was parents giving up. They almost expected their child would die. Now, they expect something else can be done. Change takes time.”

Why serve the poor and underserved

For Schubert, his lifelong work is based on his strong faith.

“In medical school, I was exposed to the work of John Perkins. He started Voice of Calvary ministries in Mississippi and had this idea of Christian community development. When I was a second-year medical student, I heard someone speak about using medical care for underserved communities. John’s philosophy included the three R’s--Relocation, Reconciliation and Redistribution. For me, relocation was moving to a neighborhood of need that I felt God was calling me to, so we moved to Over-the-Rhine (OTR).“

He lived in OTR for about 18 years, went to church there and got to know the community. That’s when he joined other community leaders in founding the Crossroad Health Center.

“I remember the first six months it was mostly volunteer staff. We had only 200 patient visits in six months. And now we have more than that in a day.”

Crossroad now has five sites, including two school health centers with almost 44,000 visits last year. Schubert stepped back from it about three years ago but is proud of the work he helped start there.

And his interest in global health?

“Well, my wife grew up in Cameroon. When I was a fourth-year medical student, my wife and I went to Cameroon for a two-month rotation in a pretty rural hospital. Twenty years later, our boys were young, and we thought, we’ll expose them to Africa. We then took six weeks in the summer and worked in Zambia. That trip really impacted our family. We ended up going back for a little over a year.”

Subsequent trips have included stints of various lengths in Malawi, Zambia and Kenya. He and other colleagues in Emergency Medicine were instrumental in starting a partnership between Cincinnati Children's Emergency Medicine Division and Kamuzu Central Hospital in Malawi. The partnership is improving clinical care for Malawi’s children, providing an international experience for Cincinnati Children’s residents and helping to train Malawian medical students.