A lifetime commitment to Tanzania brings progress and reward
Sometimes it’s hard to see progress. This from a man who has spent the last three decades improving health for the people of Tanzania by leading widespread community health campaigns, building two hospitals, and creating higher-quality training programs for health workers.
But Mark Jacobson, M.D., M.P.H., University of Minnesota Medical School Class of 1978, is surrounded by need every day, and he knows that improving health is not just about getting medical treatment.
“People have poor health because they’re poor, and until that changes, there are some impacts that can be made in health,” he says. “But without that underlying rise in the economy and the well-being of people and the access to education it’s a very difficult process to bring lasting change.”
That doesn’t mean he plans to stop trying.
In February the American Medical Association recognized Jacobson’s work in Tanzania with its prestigious Dr. Nathan Davis International Award in Medicine. He also received the University’s Outstanding Achievement Award in 2001.
A perfect match
Jacobson, a native of Stillwater, Minn., initially visited Africa as a first-year medical student on a trip with his father, a businessman.
When they arrived in Tanzania, Jacobson says he was overwhelmed by the needs of the community — the need for facilities, personnel, infectious disease control, money, and so on. “Everywhere one looked there was need,” he says.
That trip gave his life a new direction. “I found this incredibly perfect match of my gifts to the needs of a community, which for me was a sense of calling,” Jacobson says, and he dedicated the rest of his training to prepare for a career of service there.
Part of that training was a master’s degree in public health from Johns Hopkins University, where he met his wife, Linda. They got married in October 1982, and left for Africa the next month.
Building better health
The Jacobsons’ first priority after they moved to Tanzania was to employ a community-level, primary health care strategy to improve water quality, nutrition, and sanitation practices. They also promoted immunization, worked to encourage healthier lifestyles in the village, and trained Tanzanian people to help prevent and sometimes treat common illnesses such as malaria and childhood diarrhea.
“We had about 400 villages incorporated into this effort to empower people to [make an] impact on their own health,” Jacobson says, “rather than the external, ‘Let us come and give you health,’ which really doesn’t produce results.”
After they had seen some improvement in these larger public health issues, they started to realize just how few clinics in the area could provide quality care to people with greater needs. Their small clinic couldn’t keep up with the demand for its services, so with Jacobson’s leadership, it expanded into a larger health center, eventually becoming Selian Lutheran Hospital, a 10-building, 250-employee facility, located about 8 miles outside the city of Arusha, Tanzania.
Meanwhile, the city of Arusha was growing rapidly, but it also lacked a quality medical care facility. “Prayerfully and fearfully,” Jacobson says, his group proposed building another hospital in the city. Arusha Lutheran Medical Center was completed in 2008.
“I’m quite confident that it’s the outstanding hospital in the country of Tanzania today,” he says.
For more than two decades, Jacobson has welcomed third- and fourth-year medical students from the University of Minnesota to complete rotations in internal medicine, pediatrics, surgery, and obstetrics/gynecology at his hospitals through the U’s International Medical Education and Research (IMER) program.
“Because of the extraordinary leadership and mentorship of Mark Jacobson at Selian Lutheran Hospital, more than 30 U of M medical students have had their eyes, minds, and hearts opened to the life-threatening health disparities in most of Africa,” says IMER director Phillip Peterson, M.D.
And while they’re there, Jacobson finds it only fair to warn the medical students that this type of experience can be life-changing. (In his fourth year of medical school, he went back to Tanzania and completed a rotation in the clinic that, under his guidance, eventually became Selian.)
“I tell the students, ‘Be careful. I was where you were 40 years ago, and I’ve been here ever since,’” Jacobson jokes. “It’s rewarding. It’s fulfilling. The multitude of the challenges is invigorating — and frustrating as well.”
For instance, when he arrived in Tanzania 30 years ago, the average life expectancy was 62. Today it’s 48.
“That’s a result of the AIDS epidemic,” he says. “Much of the progress has been undermined by the epidemiology of HIV and AIDS.”
That’s just one reason Jacobson is hesitant to celebrate the country’s health successes over the last 30 years. The daily reminders of poverty are another.
But he does pause occasionally to reflect on the progress that has been made. His goal all along was to develop a Tanzanian institution that could sustain itself without help from outsiders — which often ends up being temporary help. And today, of the combined 550 employees at the two hospitals he has established, all but four are Tanzanian.
“It’s astounding what has been accomplished,” Jacobson says. “But on a day-to-day, and even year-to-year basis, it’s sometimes hard to appreciate.”
By Nicole Endres, managing editor of the Medical Bulletin