Keeping promises was always important to Mary Healey-Sedutto, former executive director of 25-hospital Catholic Health Care Network in New York and healthcare adviser to the late Cardinal John O'Connor and the Archdiocese of New York.
The archdiocese had sent Healey-Sedutto on numerous medical missions to Central and South America after natural disasters such as earthquakes and hurricanes and she knew that helping the needy in those locations was one of the cardinal's passions. She says that finding a permanent means of delivering healthcare to those nations was important to him.
"Two weeks before his death I had a chance to say goodbye to him, and he spoke to me about what I would do after he was gone," she says.
So a year after his 2000 death, she launched a new career at age 53. She quit her executive post and founded Hope for a Healthier Humanity, a not-for-profit foundation that is Catholic in origin but more broadly based in membership.
"I'm doing this to fulfill a promise to him," says Healey-Sedutto, a former vice president of strategic planning and business development for Saint Vincents Hospital and Medical Center in New York. "He wanted me to do this."
After struggling for a year or two to find its financial footing in a depressed economy, the foundation has increased its budget to $648,000, nearly two-thirds of which comes from donated equipment, supplies and materials; HHH has received funding from nearly a dozen foundations. Healey-Sedutto says she would not accept a salary for the first three years of the foundation and has not. She and her husband, Stanley Kosan, a dentist who serves as the foundation's chairman, operate the organization out of their home with only a part-time assistant.
"My husband rolls up his sleeves and pitches in, too," she says, noting that on medical missions he teaches and performs dental surgeries.
The foundation isn't building hospitals but helping them, with the backing of some U.S. healthcare systems. Healey-Sedutto rents a warehouse in New Jersey and relies on donations of money, medical equipment, prescription drugs and supplies from U.S. hospitals, health systems, medical schools and other donors to support HHH.
She says the money is spent on airfare, food and lodging for volunteers and consultants during medical missions and also on shipping materials.
A worldwide web
Her efforts, which sparked an annual Latin American healthcare conference three years ago, culminated in the formation of the Pan American Catholic Health Care Network, which was formally incorporated as a 501(c)(3) charity based in Palm Beach, Fla., last month. Its membership, while not including organizations, does include individuals representing healthcare organizations as well as government and church agencies. It comprises American and Latin American hospital leaders, doctors, academics and local and national public health officials and Roman Catholic Church leaders from a dozen countries. Nearly 50 members representing 12 countries met in Santo Domingo, Dominican Republic, in April to complete a collaborative vision for the newly formed network.
Healey-Sedutto says members discussed ideas for the bulk purchasing of prescription drugs. Both the quality and price of pharmaceuticals pose problems for members, she says. In addition, the members explored linkages between their systems and U.S. partners for improving quality and promoting continuing medical education and clinician training.
"This is more than just another charitable organization of do-gooders performing medical missions," Healey-Sedutto says, pointing out that the focus on medical education, training and building infrastructure differentiate it from traditional medical mission organizations. The needs of the member countries differ, she explains. In Brazil, for example, a physician is spearheading the development and implementation of a continuing medical education program with Harvard Medical School to monitor and prevent medical errors. In Uruguay, health officials are interested in identifying sources from whom to purchase used high-tech medical equipment.
"(Uruguayan hospital officials) have money; they're not looking for donations but where they can buy the second-to-the-most-recent generation of equipment. In Honduras, they're looking to purchase good quality medicine because their current suppliers of pharmaceuticals have delivered products of questionable quality," Healey-Sedutto says.
And an Ohio school of osteopathic medicine is exploring a program to send OB/GYN residents to a hospital in Honduras' capital city of Tegucigalpa to gain more experience in delivering babies.
"It's a win-win situation," Healey-Sedutto says. "They get good doctors and our doctors get better training."
The network is creating a database linking the needs, resources and wish lists of the member countries with American healthcare institutions in a position to both offer assistance and benefit from the relationships.
Paul Danello, a lawyer with the Washington office of Ropes & Gray who represents HHH and the Pan American network, says Healey-Sedutto was Cardinal O'Connor's emissary on international disaster issues.
"Mary commandeered cargo planes and took supplies, equipment and a team of volunteers down. After doing this for years, she became interested in the absence of a coordinated healthcare system in Latin America. In some countries the government ran programs and in others the (Catholic Church) did, and frequently they overlapped. She thought that a healthcare foundation could make an impact here," Danello says.
Danello says the Pan American network employs a hub-and-spoke concept, with the foundation staff and its board reaching out to understand the needs of underdeveloped Latin American countries.
"It could be installing an elevator in a Haiti hospital that has never had one, delivering equipment and supplies to a poor barrio clinic in Sao Paolo (Brazil), or finding ways to break through the pharmaceutical monopolies in some countries that prevent distribution of affordably priced drugs," Danello says. "Mary has key contacts in those countries, and those contacts serve like the spokes for transmitting information. The foundation then figures out how to meet those needs as inexpensively as possible."
Focus on follow-up
Charles Schmidt, a Sao Paolo physician and one of the five trustees of the Pan American network, says HHH differs from many other foreign-aid organizations in both its mission and execution. Schmidt, a pediatric infectious-disease specialist, says some organizations go on medical missions to meet needed services but leave without any follow-up.
"Hope for a Healthier Humanity doesn't deliver care," says Schmidt, who does not hold an official position within the foundation but works with it closely. "We are not hands-on. We sometimes use other agencies. This network uses our major capabilities to analyze those projects to improve the likelihood of resumed funding. Understanding what happens locally, we get information to people who want to make donations."
For example, Schmidt, who has been working with Harvard Medical International, a division of the medical school that partners with international organizations, says medical errors remain a major problem in Brazilian hospitals and clinics.
"But I cannot tell you how big because we don't have the numbers. No one is analyzing them," he says. He is working with Harvard to develop and disseminate a six-hour program in preventing and avoiding medical errors that can be taught to physicians, nurses and pharmacists. He also hopes to take the program to other Latin American countries. After completing the course, providers would be certified by Harvard's institute, an important step toward improving quality.
"With this training we hope that health providers can implement strategies in hospitals and physician clinics for improving quality," Schmidt says. "We would like to spread this program with the philosophy of training the trainer. It's a different approach. We use our expertise in health management in each country to analyze projects and direct them to the right people who can perform the task. It's a facilitative and analytical approach. We function as an intermediary with regulatory agencies, governments and nonprofits to provide better results so corporations and donors can invest their money more wisely to obtain better results. In this way I think we can deliver better value more efficiently because we understand local needs."
He says that because Latin American countries are generally poorer, they have learned how to deliver healthcare using fewer resources.
"American hospitals and health organizations can learn from us as well," Schmidt says. "When they are delivering to our network, they also gain social revenues and returns."
Healey-Sedutto has tapped her former hospital administrator colleagues for moral and financial support. Ken Raske, president of the Greater New York Hospital Association, chaired the foundation's first fund-raiser last year.
Raske says healthcare executives respond to Healey-Sedutto's requests for help because of her longtime advocacy for the poor and needy, both domestically and worldwide.
Several American healthcare executives have accompanied her on medical missions and fact-finding visits. John Kastanis, president and chief executive officer of the Hospital for Joint Diseases, New York, says Healey-Sedutto is highly regarded for her organizational and strategic-planning skills.
"And she's a very devout Catholic who really lives her faith," Kastanis says. "She has always embraced the Catholic healthcare mission of serving the poor and the needy. So it's natural that someone who has done all this volunteer work would be led to this."
He says that over the years Healey-Sedutto has gained many contacts in the boardrooms of American corporations, foundations and healthcare organizations.
"She knows a lot of healthcare executives and where resources emanate from," he says. "She knows who to call if she needs an incubator or antibiotics. She's knocked on our door and asked for pharmaceuticals, and our director responded. We've sent orthopedic surgeons to provide treatment. She has connectivity."
Healey-Sedutto says she always is seeking further partnerships with other U.S. hospitals.
"They could be very helpful to us in a number of ways," she says. "Latin America does have some very sophisticated hospitals, but in some cases they need access to quality clinical education. American hospitals have some excellent telemedicine programs and there may be opportunities for linkages."
Help from the top
Healey-Sedutto has been keeping some impressive company. In addition to meeting with Cardinal Oscar Rodriguez Maradiaga, the archbishop of Tegucigalpa and past president of Latin American Episcopal Conference, she has met with presidents of some of the countries partnering with HHH. Healey-Sedutto says Rodriguez has taken the organization under his wing.
"He has seen healthcare receding in Central America and is concerned," she says. "And when the healthcare systems weaken in those countries, we are at greater risk, too. Diseases like SARS and AIDS can spread rapidly from one part of the world to another."
The recent onset of severe acute respiratory syndrome, monkeypox and other communicable diseases unheard of in the U.S. only a few years ago, the rapid spread of tuberculosis worldwide and the growth of AIDS in underdeveloped countries brought a high-ranking U.S. health official to the Santo Domingo conference. HHS Deputy Secretary Claude Allen addressed members and spoke of the Bush administration's commitment to fighting AIDS. He also cited the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is sponsored by the United Nations and financially supported by the U.S.
One of the most promising programs to evolve from Healey-Sedutto's efforts is a relationship forming between Honduras and the Ohio University College of Osteopathic Medicine. The osteopathic school based in Athens, Ohio, has sent its doctors and staff to Africa and Latin America on medical missions and already has met with the president of Honduras and Rodriguez. School officials say they hope to develop a more formal and permanent partnership with a hospital in Tegucigalpa, the Hospital General de San Felipe.
Officials from the hospital and osteopathic school hope to send osteopathic residents to improve their clinical skills and seek an academic component that might include telemedicine programs. The hospital delivers more than 30 babies per day, offering clinical opportunities unavailable in the U.S., and Honduran hospitals gain needed clinical and academic support.
"Our medical missions differ because I always insist on an academic component along with the clinical support," Healey-Sedutto says. "Our providers treat and teach dental or medical students. They lecture and instruct and give hands-on training."
Healey-Sedutto says she heard of a physician assistant at the Kettering (Ohio) Medical Center Network who maintains a warehouse of used medical equipment and excess supplies. She contacted the woman, Marge Cook, who collects the materials and distributes them to medical missions, including some by the osteopathic school. Cook accompanied Healey-Sedutto on visits to Haiti and the Dominican Republic, further cementing HHH's growing relationship with the osteopathic school. At the time, the osteopathic school was seeking better ways to train its doctors in cultural competency and diversity when their officials met Healey-Sedutto.
Medical missions are noble and helpful, but sporadic and episodic, says Peter Bell, an emergency physician and regional dean of the osteopathic school. "That doesn't fit well with the osteopathic model of comprehensive, holistic continuity of care."
Bell says the school has been seeking to form a relationship with a country with a stable government and is considering Honduras. This year it sent several doctors along with Healey-Sedutto on a visit to Tegucigalpa.
"What do we get out of it? There are those who feel the work is very philanthropic," he says. "Some feel called to do this as part of their professional obligation or a religious calling. From the university's perspective, we see the importance of cultural competency. Working in a Spanish-speaking country would give (the osteopathic resident physicians) more motivation to better learn the language. And over time we hope other exchanges will take place with other schools in the university, like the departments of education and business. We see this like a sister-country relationship."
Bridget Wagner, assistant dean for the Ohio Region of provider consortium Centers for Osteopathic Research and Education, or CORE, attended the conference in Santo Domingo to cement the growing relationship between Honduran officials and the Ohio University school.
"This could grow beyond just Honduras," says Wagner who has made three trips to Tegucigalpa. "We're setting up an infrastructure that could one day lead to informational exchanges and resident rotations in Brazil and Uruguay."
Wagner says the osteopathic school wanted to build upon those medical fly-ins. Wagner, a family practitioner and a former international gymnast, says: "Together we're trying to create something lasting, to learn the country's needs and how best to satisfy them. We don't always have the answers in the United States. We think our students will benefit by seeing different diseases and performing more procedures. They'll benefit not just clinically but culturally and politically. They will be more global and see how the world really is."
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