Cindy Haq, MD, remembers passing poor children on the streets in her hometown of Lahore, Pakistan and wondering why they often did not have food while she did.
“At age seven, I realized there was a big difference between my life and theirs,” says Haq, a professor of family medicine and population health sciences in UW–Madison’s School of Medicine and Public Health. “I was beginning to wonder about suffering—and why the world was neither fair nor just.”
She remembers the day she asked why many children did not have food or proper clothing to her American mother. In response, she was told, “there but for the grace of God goes you.”
Ever since, it seems, Haq has been earning that grace.
As a family physician, Haq has practiced in Belleville, Wisconsin, a town of less than 2,000 people about 20 miles outside of Madison for 19 years. But as director of the UW–Madison’s Center for Global Health, Haq spends a good deal of time in very different locales, working to improve healthcare for medically disadvantaged populations.
As the founding director of the center, Haq is effusive about the need for students in the health sciences to understand how healthcare in their own communities can be informed by communities that can seem vastly different from their own. And when she takes students with her into the field, she says, she witnesses one “ah ha!” moment after another.
“Going abroad and seeing other cultures really jolts people that way,” she says. “They see how many things impact health such as access to clean water, food, education, and social support. I know that my work in Uganda has helped me to be a better doctor in Belleville because I’m more attuned to people’s lives in the context of their families and their communities,” she explains. “I’m more attuned to prevention, health behaviors, end-of-life care…It’s essential to see people as part of a network.”
When asked how she gained her own international perspective, Haq says, “my story is one of globalization.” Her father, an officer in the Indian army, met her mother while he was training at Fort Knox, Kentucky. She, a native of Indiana, was there for a summer job.
As the child of two very different cultures, Haq learned early on the art of cultural translation.
“When I went to medical school, I knew I wanted to do something international,” she says.
But it wasn’t until she was in her residency in 1986 that Haq was able to find an opportunity and the means to take her family (then a husband and three children) into the field.
“I felt strongly that our family should live and work abroad together,” she says.
The Minnesota International Health Volunteers sent Haq and her family to Uganda after the civil war had just ended. During that war more than 300,000 people were killed and hundreds of thousands were left without homes. Medical assistance was badly needed; one in three children did not live to the age of five. Dr. Marc Hansen, then UW family medicine residency director, agreed to let Haq work in Uganda for her pediatric elective.
Haq became medical director of the Kasangati rural health center and trained village health workers to improve child survival. But she quickly appreciated that there were already teams of skilled health workers, if not doctors. In fact, many of them ended up teaching this young doctor about malaria, tetanus, and other illnesses she hadn’t yet encountered.
“My job was to see how a doctor could improve the quality and delivery of health services.”
She had her own “ah ha” moment while in a village health meeting where the village chief addressed her.
“He said, ‘you are the most educated person who has ever visited our village, and thank you for coming to train the village health workers,’” Haq remembers, “’but the problem is that we don’t have access to clean water. All the people in the village must walk at least 6 kilometers to get water from a muddy ditch. This is why our children have diarrhea’”
This experience shifted Haq’s efforts towards prevention and public health. Having access to a vehicle, Haq visited with government officials to advocate for wells and clean water in the villages. “As physicians and high profile visitors,” she says, “we can serve as advocates, bring visibility, and And in the midst of such devastation, she also learned the importance of teaching, and not just treating.
“Early on, Josiah Mafigiri, the Ugandan clinic administrator told me, ‘you cannot treat patients on your own. Your job here is to teach. You could see patients twenty-four hours a day for the rest of your life and not make much difference as you will never be able to reach them all. But if you are teaching in every visit, even if you are only here for a short time you will make a long lasting difference.’” Haq made sure that one of Mafigiri’s staff was with her at all times.
“After the war there were horrible sites where there were mounds of skulls and body parts piled up wherever you looked,” Haq remembers. “And there I was, trying to teach public health!” In the midst of such devastation, she hired a local artist to paint a mural on the wall of the Kasangati health center that would illustrate a healthy village. In 2004, Haq returned with students and took this photo. “When I went back, the amazing thing was that the village looked like that mural!”
Haq has since trained scores of health workers in Uganda, established family medicine training in Pakistan, served as a consultant to the World Health Organization, and worked to improve medical education in countries around the world, including Afghanistan, Brazil, China, and Iran.
Since 2004, she and Professor Linda Baumann in UW–Madison’s School of Nursing have also led groups of
UW health professional students to study in Uganda. She says she savors the opportunity to “turn on” students in the field.
“Many of the students come from small towns in Wisconsin and have never been out of the country before,” Haq smiles. “This year we took one who had never been on a plane!”
One of the greatest things about an education in global public health, she says, is the perspective healthcare professionals maintain long after the experience.
“Once students return, they see healthcare in an entirely new light,” says Haq. “It gives them the mindset of caring for populations instead of individuals. Here, we train doctors to take care of patients one at a time. But public health has a different approach. It teaches health workers to consider the patient’s entire network.”
And as all of our networks expand, Haq says, global public health will only become more essential.
“This is the way medicine is going.”