Cinci Cares Presents: Doctors on a Mission | Mark A. Snyder, M.D.
Good Samaritan Hospital Orthopaedic Center of Excellence, Medical Director
LEAD Magazine: What inspired you to do this type of work?
Dr. Snyder: I have always done mission work as part of the practice of being a Christian. I have done work with groups like Christian Medical and Dental Associates and Christian Hands in Action out of El Paso, Texas. It wasn’t until I had to fall on my knees in 2010 and beg the Lord to give me an insight that I could find nowhere else in medicine, as to how to radically change surgical process for adverse event reduction. This clinical science innovation later on led to the medical mission work our foundation now does throughout the world.
After this cry for help to get an inspiration that would lead to real healthcare innovation, on March 25, 2010, the Lord awakened me in the middle of the night to analyze these problems with a simple three-step process called “Before, During and After.” This morphed into a program called Zero in on Zero.
It began asking for game-changing solutions for total joint replacement problems like how to avoid blood transfusion or a surgical infection. Newly queried was what mitigable heath risks are present in that patient before surgery, what could be done differently during surgery to reduce their risk and what can continue after surgery and during recoveryto further drop the risk. When these three questions were asked in the same way, something remarkable began to happen for a n umber of major problems, including falls in the hospital, blood transfusions, blood clots, surgical infections, total hip dislocations, patient dissatisfaction with their result, poor pain management and poor discharge handoff situations.
When the same solution was used for all of these, synergistic power occurred that created a result that is now virtually 10 times better than U.S. average. This radical improvement has nothing to do with my surgical skill or ability. I’m experienced and I know what I am doing, but this has to do with things that go beyond a doctor’s license, their expertise or even their best efforts. This is improving processes and problem-solving methods that can be integrated into a healthcare system where doctors perform total joint replacement surgery.
There have been national efforts to take on one problem at a time, whether it is infection or pain control, but the problem is that these efforts generate huge documents and cumbersome analyses that are difficult to translate into simple practice solutions in a hospital or a doctor’s practice. Instead, Zero in on Zero creates a single-page summary for every problem that can be followed on a cell phone or executed in a healthcare system when embedded in clinical pathways. When I do surgery now, I still do it with, I hope, good care and skill and do it for the right reasons, but this large process improvement makes the necessary joint reconstruction surgery safer. As a result, this reduction in complications, readmissions and adverse events that can harm people is registry proven and available to any doctor and health system.
LEAD Magazine: How does this relate to missions?
Dr. Snyder: On August 29, 2012 I was awakened again with an insight to take this scientific method and apply it to world health. An interest that I had for a long time was neglected tropical diseases that affect almost 1.5 billion people. These diseases occur due to worms and other parasites and ravage mankind, especially in the 10/40 window where there is great poverty. We had an opportunity for my oldest son, David, to use his non-governmental organization experience in Habitat for Humanity and other poverty improving efforts to lead this program with me.
All 6-foot 8-inches of him, with a great heart and passion to be a good networker with people, moved his family to Cincinnati and started to work without any guarantee that it would ever succeed. We formalized an association with a great worldwide ministry called Burnham Ministries International (BMI), one of the top training, NGOs in the world. In fact, they earned a second-place award for worldwide mission efficiency a few years ago.
By doing this training, at low cost but at high value, their expertise essentially propelled our efforts. Dr. Jonathan Burnham, the BMI founder is a good friend of mine. When these ideas came together, I had an opportunity to receive a sizable investment that provided the resources to start this foundation. Hopefully the administrative costs will be covered by this for a few years to come .
What we did then was take the Zero in on Zero scientific method and apply it to see if it had any impact on world health. We prayerfully considered that we would tackle some of the major challenges in like malaria, leprosy, worms and other parasites. We invented a simple “before, during and after” method (similar to the clinical science discovery) that could be taught in a village so the residents could better solve their own healthcare problems; so they could heal themselves in a way.
We spent time with experts and consulted with some very well known Christian healthcare leaders who heard about the idea and said they wanted to be involved. We had a lot of help writing curriculum. We wrote world-class teaching on leprosy, ascariasis, zilariasis, lymphatic filariasis, any number of these terrible diseases that can be used as a Grand Rounds any place in the world. That teaching is done in such a way that it is well annotated with best citations and then at the end of each one of these Grand Rounds style presentations, there is a single page summary – “before, during and after” of what can happen in a village.
We combined that with four fundamental Christian teachings that are part of the course. They have to do with suffering – does God care? That is a very important question around these issues. Most people would say, no, he doesn’t, if I am suffering like this. The second one is to establish the divinity of Christ powerfully revealed in the crucifixion; that the crucifixion itself assures that He is actually God. And then we teach the bodily resurrection in the same way since that is the cornerstone of Christian faith. We consider prayer ... how does it really work? What did God say it should be like? What can be done in and through prayer? Not in a way that many well-intentioned organizations have done, where they will go into Africa and say, “Let’s name it and claim it.” Our teaching on prayer is actual biblical, authentic, filled with rigorous questions about what does the bible really say about what can really be done in prayer?
The faith topics are taught with courses that are medical and scientific in nature. Those that attend the courses – pastors, doctors, healthcare leaders – go back to their districts and villages and something wonderful begins to happen. We started in Uganda and Kenya and have expanded into Rwanda; next year we will add Zambia and Ghana. We have been to India and when these courses are given, those that attend can help change a village. Whether it is a Catholic church or a Protestant group doesn’t matter. When the villagers and their leaders see pastors, doctors and trained healthcare workers with solutions so simple that the village could do it, they start doing it.
This is an almost first in history occurrence. The world has done a good job, World Health, the Gates Foundation and others provide money and resources for drug distribution to fight many of these diseases. Yet the hardest thing of all is teach people to solve their own problems in a sustainable way since they might not have access to medication. When you have the medication, our holistic approach is more successful. As a result of these efforts, in the third year of our foundation’s existence, more than 205,000 people were newly diagnosed and treated in African countries in a way that follows this medical and faith-enabled problem-solving village format. This is teaching fishermen to fish. That is exactly what it is.
We have an open-platform website. We give away the teaching for free. We are a significant granting NGO in America. To be a large granting foundation in America, you don’t need to give a lot of money because there aren’t many who give international grants for education, research and community improvement. We give grants that actually can allow faith and medical leaders in these countries to receive further training or support research programs in their villages or their districts to embed these ways of solving entrenched problems.
We are blessed to hire a full-time African continental leader, Pastor Emmanuel, who survived the Rwandan genocide by escaping under the slaughtered bodies of family members. Through God’s miraculous grace he found himself leading some of the reconciliation efforts in Rwanda. And we have hired a leader in India, Pastor Biswah, who is a modern day Peter or Paul in terms of what he has survived and been willing to do for the faith as he ministers to people and survives threats against his life, including guns to his head.
The Sustainable Medical Missions program is now mature enough that it can be carried out anywhere in the world. We hope to extend into Southeast Asia where BMI’s work is so successful. We try to go deep before we go wide, and we try to make sure that we have continental leaders who can carry this work forward. We have enough training visits, two or three usually, to have the program established in the hands of the nationals to carry it out themselves.
When we did the leprosy curriculum, I actually worked with the American Leprosy Mission. We wanted to create a curriculum that would work in India. With their help and constructive criticism, this curriculum emerged. We have also produced curriculum and simple village-enabled solutions for the diseases that affect almost a billion and a half people, including ascariasis, roundworm infestation.
Churches are overflowing with people in villages and districts who are eager to attend. The biggest problem is not enough churches, not enough buildings. We have actually started a select building program called Life Centers for some of our established partners. For $2,000 a Life Center can be funded. It is built with the sweat equity of the villagers to create a structure for church, healthcare teaching, women’s education, child-rearing help and any number of things. Not only have many of the Life Centers started, but we are actually beginning a Center of Excellence program where, in certain districts and with certain leaders that are nationals, the program can be so well taught, and established that nationals are sufficient leaders of Center of Excellence to propagate for decades. This is all part of Sustainable Medical Missions.
This is not a typical story about a doctor doing missions. I have had the privilege of teaching young national leaders and pastors. I am privileged to learn from them. Under their guidance, we walked through the villages and saw something so basic as the lack of latrines. We are blessed to have witnessed a latrine built, with our funds, to help an entire school district. In these kind of cost-effective efforts, Christian and medical education approaches help solve scourges.
I like to say that Christianity without compassion is not Christianity. Jesus, when he was with us incarnate, his work was great news through His and teaching and miracles. In Christ God is with us and He knows our sufferings because He came right down into them with us. Christ performed many miracles, and many more occurred than were recorded as John explains in his gospel. Almost half of these were medical miracles. I think it is safe to say that the gospel that Jesus taught, without compassion, is not the gospel that Jesus taught. We like that to be very characteristic of what we do. We honor His healing. We depend on His grace. Through Him we care for those who the world would regard as the “least” among us.
LEAD Magazine: Your son is the director of Sustainable Medical Missions?
Dr. Snyder: My son, David, is the executive director of our public 501(c) 3 non-governmental organization. We have a wonderfully active board. This year, more than 130 people gave us financial gifts to support the ministry work – people from Seattle to South Carolina to communities where very generous people have supported this work. The generosity has nothing to do with the dollar amount. We have had people give us gifts that let us write brochures to explain the program. We have partnerships with agencies like Caring Partners International, Call of Love ministry, Burnham Ministry International, American Leprosy Mission and on and on. We really need to be partners, not competitors with those who are doing equally good and important work.
LEAD Magazine: Are you doing orthopedic surgery in these places?
Dr. Snyder: No, because the need is so much greater for neglected diseases and neglected people. The need is so much greater than the joint reconstructive work I so dearly love to perform. I do still travel around the world, usually with sponsorship from a company such as Smith & Nephew to do demonstration surgeries and total joint replacements. I have been blessed to visit most of the countries in the world.
LEAD Magazine: What has been your favorite place?
Dr. Snyder: I would say China. The reason is two-fold. One, you get a “license” to be an orthopedic surgeon with varying levels of training. So when I went there and demonstrated a total knee replacement, their response was, “We have never seen a perfect total knee.” That tells you that they are not adequately trained to do it. There are many good surgeons there, but it is a level of training that is still quite primitive in some respects. Second is I have shared my faith in China and many other places where it is difficult to do that. People at dinners and conferences ask me about the United States and they ask me about Christianity. Without any regard for what could happen, I openly shared. They were very warm and generous about receiving it.
LEAD Magazine: What have you learned by doing this work?
Dr. Snyder: I have learned three big things. Number one, it is always a good idea to fall on your knee and beg the Lord to help because out of that comes a richness of discovery and innovation that can lead to some of these things. The second thing is I’ve learned that the great lie in the world is that the poorest of people and the most desperate would not help themselves if they were given the tools to do it. I’ve heard that from many famous agencies and governments. We’ve discovered that is not true. That is a lie and when they are given the right tools it makes sense in light of their own resources and capacity for change. And number three is that I have increasingly learned that the beauty of the good news of the gospel is that people like me, who deserve nothing, can always in Christ, find healing and hope and usefulness. Even more, I know we were made for eternity with the God who created us and saved us.
LEAD Magazine: Would you like to continue this work as long as you are able?
Dr. Snyder: I plan to continue to do total joint surgery until age 70, but I increasingly give time and resources to this medical mission work. As long as TriHealth will allow me, I will continue to do both orthopedic surgery and do clinical translatable research. I will increasingly be involved in Sustainable Medical Missions if the Lord continues to give to this foundation, which is needed every year. Every year a foundation must seek funds unless you get an endowment. You have to continue to have a story that is convincing and honest and challenging in order for people to want to support it. We plan to let this spread all over the world, but do it in a way that lets us be out of the picture in three-plus years. Wherever we go we want the fame be for the Lord, and for the people themselves who can carry it out to their credit and for their benefit.
LEAD Magazine: What message would you like to share with our readers?
Dr. Snyder: I want the people to realize that there are process improvements in life, in medicine, in science and many other areas that could change everything. I want them to realize that these process improvements can be used anywhere in the world to affect horribly common problems. I want them to know that the essence of innovation and discovery is crying out for help, opening your eyes to see what is happening, and asking why it happens so that you would discover new solutions. If those three steps are taken, everything can change. To God be the glory!
For more information about Sustainable Medical Missions or to contact executive director David Snyder, visit sustainablemed.org.