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an online version of the magazine Fall 2009
Features
The Long Way Here
 
  Every physician is a master of delayed gratification. From primary school on, a future doctor’s rise builds on an ability to scale escalating hurdles at the expense of personal comforts. But some are driven by forces beyond the burning desire to heal ailing people. For these doctors, a need to forever transcend their personal histories propels them to overcome long odds. In the three stories that follow, you’ll meet a trio of Hopkins heavy hitters whose odysseys have never publicly been shared … until now. Somehow, we suspect, the sacrifices behind their journeys give an extra heft to their stethoscopes.

video WEB EXTRA Video: For a five-minute video of one doctor’s personal journey to Hopkins.

By Ramsey Flynn
Photography by Mike Ciesielski
 
 
 
 

Escaping the Killing Fields

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Escaping
SHELTER FROM THE STORM: Though the horrors of 1971 still haunt him, Hamid Rabb refuses to see himself as a war refugee. From left: Wife Nausheen, Hamid, Samy, Adam, and Neil.

“All of you, stay here!”

Hamid Rabb was just 8 years old on that early morning in 1971, when his father tersely issued that order to him and his family. They had taken refuge all night in their home’s inner pantry, while outside a blitzkrieg of soldiers, tanks, and rocket-propelled grenades all bitterly contested a coveted bit of real estate between India and Burma.

Unable to contain his curiosity, young Hamid disobeyed, sneaking away from his mother to a low-hanging window. The sight outside froze him. Men in army uniforms were operating camouflaged bulldozers, scooping up dead people as if they were the stuff of a spoiled farm crop, then dumping them into earthen pits. Hamid gaped wordlessly, unable to comprehend.

At some level, he understood the bodies were those of the students who’d occupied the all-Hindu dormitories across from the faculty compound where Hamid lived. His father was an esteemed professor of philosophy at Dhaka University. Hamid had accompanied him on frequent dorm visits with the students. He knew these people. Really wonderful people. Why would anyone kill them?

Part of what Hamid didn’t know was that all members of his ethnic group, the Bengalis, were next on the soldiers’ list for elimination. The new wave of killings would start with the professors.

Fast forward to a comfortable white brick home at the end of a forested driveway in Ellicott City, Maryland, where Hamid Rabb looks both serene and very arrived. He is now a Johns Hopkins nephrologist who focuses on diseases of the kidney and urinary tract. He serves as the Hospital’s medical director for kidney transplantation and professor of medicine. He recently became the vice chair of Medicine under Mike Weisfeldt, and has been adopted by Dean Ed Miller as an attractive candidate for fast-tracking into almost any senior leadership post.

He also did not want to tell this story. “I felt a little embarrassed,” he explains quietly. “I didn’t think it would be fair if I were portrayed as someone who had to struggle. I didn’t really have to suffer.” In trying to reconcile the course of his life, it seems, Rabb feels more like a child of great fortune than a war refugee.

Rabb remembers his pre-war life as perfectly idyllic. He was born in the university city of Dhaka, the scion of multiple generations of academic leaders; his father, Abdur Rabb, was a rising philosophy professor who moved his family to Canada to pursue his doctorate in theology and mysticism.

Once ensconced in Montreal, the Rabb family’s household served as a magnet for visiting spiritual leaders from every major tradition. Hamid recalls it as a “really respectful environment,” where the quality of discussion centered on a scholarly sharing of spiritual and philosophical ideas. Young Hamid sat in the laps of some major figures, including Srila Prabhupada, founder of the Hare Krishna movement.

When Professor Rabb returned to Dhaka in 1970, there was little talk within the professors’ compound about the roiling hatreds that divided Pakistanis from Bengalis, Muslims from Hindus, nationalists from freedom fighters. And so the military blitz arrived without warning on the late evening of March 25, 1971, as Hamid’s parents urgently woke him from sleep at midnight.

In the morning, and within an hour of taking in the scene that would forever shatter any semblance of his childhood innocence, young Hamid took emotional cues from his stoic parents. He felt paralyzed.

The family remained cowering in the pantry amid sacks of flour for two more days before they learned that a military curfew had been lifted. After a furtive survey of the surroundings, Professor Rabb suddenly announced, “We’re leaving immediately.” Hamid clung to his puppy. “Scout needs to be with us,” he insisted.

“No,” his father answered. “He’s staying here and I will come back for him.”

It was “a 10-second decision,” Hamid Rabb says today. In moments, the small family had grabbed a few possessions and scrambled into their Volkswagen Beetle. Wanting to avoid the risk of checkpoints, Professor Rabb kept the drive short, heading to the home of his wife’s brother—a successful government official who lived in a compound of untargeted Kashmiris.

Hamid blended in with other children sheltered in the household, the outer perimeter of which became the impromptu location of a military outpost flanked by soldiers and equipment. Hamid and the others learned to keep their activities to the home’s interior, away from the windows.

And so began the Rabb family’s calculated adoption of the art of invisibility, as they took on a series of ruses that would eventually provide them safe passage away from the hostilities. They soon joined a flood of 8 million other refugees from the bloody storm that swept across their homeland, the toll from which is still debated. While Pakistani history books allow a body count of about 20,000 from an action intended to put down rebels, the Bengali media prevailingly call the action genocide, calculating the toll at up to 3 million killed. These Bengali historians place the event on a scale with those of the Nazi Holocaust, the purges of Stalin, Cambodia’s Pol Pot, and the ethnic cleansings in Rwanda.

But all agree on the results: Within months of the blitzkrieg, the Indian army joined Bengali freedom fighters in reversing the aggressions, giving birth to the present-day Bangladesh, “Land of the Bengalis.”

Many of Professor Abdur Rabb’s colleagues were either executed in the purge or died fighting it, a hideous reality that still haunts him even from his safe harbor back in Montreal, where he and his wife act as dedicated servants to any and all refugees—and the people they left behind in Bangladesh.

The traumatic experience that the Rabb family went through produced an outpouring of sympathy from their Jewish friends in Montreal, many of whom felt a common bond with their fleeing Bengali colleague. Their Jewish supporters, in fact, aided the family through an informal underground railroad that brought them through central Europe and back to Montreal by 1972.

Hamid remembers a winter of rotating shelters and Salvation Army support before his parents found work and began integrating into their new homeland. “You’re in North America,” Professor Rabb instructed his young family. “We’re not looking back.”

And as with other minority groups accustomed to a life of flight, Professor Rabb encouraged his son to develop skills that no one could ever take away from him. “At least if you’re a doctor,” he said, “it doesn’t matter where you go. You will always have employment.”

Hamid lost no time in racing through the Canadian school system, rapidly advancing with a scholarship at McGill’s Faculty of Medicine, William Osler’s alma mater. After a series of subsequent training stops that took him to UCLA and Harvard, Rabb was lured to speak at Hopkins in 2000 by former nephrology chief Joseph Handler and clinical director Paul Scheel.

During that visit, Handler reminded Rabb that he’d once spent time in India, tending to Bengali refugees fleeing the atrocities. “I know your background,” Handler told Rabb. “We could use your sort of temperament and skills here. Would you be interested in becoming the medical director of our kidney transplant program?” The fit made sense on many levels for Rabb, who also enjoys Hopkins’ high-level access to international communities, which allows him to quietly address inequities far from American shores.

Yet even as he tries to enhance his own leadership skills, Rabb has no appetite for combating the old wrongs that uprooted his life nearly 40 years ago. “I hold no historic political agenda,” he says. “I have a lot of friends from different backgrounds.” He says that though Pakistani army and senior government officials carried out the genocide, individuals among them also helped his family escape. “I don’t associate violence or genocide with any particular group.” *


 

*****

The African’s Journey

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Journey
PERFECT ARRIVAL: With dispiriting turns now safely in the past, Kofi Boahene is right where he’s supposed to be. From left: Kofi, James, Akua (with back to camera), wife Ruth, and Jonathan.

On the third day of Kofi Boahene’s medical orientation training in the Soviet Union, school officials entered the classroom and called out his name, beckoning him outside. “What’s going on?” Boahene asked, in the best Russian he could manage after arriving from his native Ghana just days earlier.

But the two officials also lacked the ability to speak in a common tongue for Boahene, and could not adequately explain their reasons for escorting the 21-year-old into the ambulance that awaited.

The sudden disruption to his nascent medical training would prove just one of many dispiriting moments in Boahene’s marathon effort to earn the white lab coat and stethoscope of a profession through which he hoped to honor the traditions of his missionary parents in Ghana.

What strikes him about it all now, as he stops to gaze out on the Hopkins dome from his office overlooking Broadway, is how many times he almost gave up the quest. At 40, married and the father of three, he is an accomplished practitioner in the most advanced forms of facial plastic reconstruction. His post in the Department of Otolaryngology–Head & Neck Surgery also allows him to perform some of the most novel approaches to minimally invasive skull base surgery. He is saving lives. He is repairing damaged faces. But all of this almost never happened.

As a teen growing up in Ghana, Derek “Kofi” Boahene (pronounced BO-a-HIN) started out on the fast track, a standout among eight children. A conspicuously precocious youth coming up through Ghana’s cloistered system of boarding schools, he attracted the attention of an ambitious medical school program in the Soviet Union. It would start with a yearlong orientation—an intensive combination of training in Russian language along with primers in chemistry and biology.

Yet soon after arriving in Krasnodar and settling into his studies, the two school officials summoned him to the ambulance. Within an hour, a very confused Boahene found himself in a remote medical facility in a small Soviet town, serving as an unhappy pincushion for a dreary parade of nurses who began a daily ritual of blood drawings.

Despite his continuing bids for an explanation, no one seemed able to communicate in a language he could understand. The seemingly unbounded hours and days grew into an agonizing uncertainty. How long would he remain in this limbo? Was this the end of the road? With no end in sight after that first week, Boahene became increasingly uncooperative, eventually demanding to be sent back to Ghana.

Instead, Boahene was abruptly returned to Krasnodar to rejoin his class, still with no explanation for his three-week medical detention. Toward the end of that intensive training year, Boahene visited the university medical center for treatment of neck pain. He was impressed to see they already had a medical file on him. As he studied the Cyrillic lettering in a language he now understood, some key words popped out: “... quarantined for risk of malaria parasites.” He could also see the series of check-boxes, all with marks in the “none” column. At long last, an explanation.

Boahene’s early top grades prompted his mentors to steer him into the more selective field of veterinary medicine. Boahene was aghast. This was not what he, or his family, or, indeed, his country, wanted. “Listen,” he protested to his seemingly well-intentioned Soviet mentors, “my country is going to lose a physician.” But Boahene’s minders assured him he’d adapt, persuading him to knuckle under for two years with an elite program in Moscow.

By August 1991, well into his second year of training, Boahene was on a brief trip to West Germany when the Soviet Union became wracked in a violent coup, plunging it into a rocky transition that unleashed waves of instability.

Boahene’s return to post-Soviet Russia was short-lived. Amid a general chaos in which foreign students were getting robbed and killed, he artfully found passage through a seemingly impervious Russian border by placing all of his personal articles in a train station locker, leaving Moscow forever with just his passport and the clothes on his back.

Boahene soon paid a visit to family friends in Arkansas, where he hoped to re-establish his medical training. The University of Central Arkansas liked his SAT scores, but he was missing two key ingredients: money and the undergraduate degree required to attend medical school in the U.S. Resolute, the determined African took a series of menial jobs, barely enough to cover shelter. He learned that he could buy 10-pound bags of uncooked rice at a discount, which he flavored with extra packets of ketchup acquired at local fast food restaurants.

At one point, Boahene worked for a fellow countryman who’d established a car repair business changing oil and brakes. Yet footing the bill for medical school began to look absurd. “You know,” Boahene said to his friend, “I don’t want to be a hustler for the rest of my life. I can’t do this medicine thing. I don’t have the money.”

His friend turned on him in disgust. “Unless you plan on dying in 20 years,” said Daniel Basie, “your job better be medicine. Regardless of how long it’s going to take you, don’t give it up.”

They were precisely the words Boahene needed to hear. Soon after, Boahene began undergraduate studies in physiology at the University of Central Arkansas, supporting himself by tutoring fellow students in Russian. He was delighted to discover that a 12-credit-per-semester load cost the same as 24. He could get his undergraduate degree in two years—“the best deal I’d ever heard of.”

By 1996, Boahene could finally feel the wind at his back. His top grades made him a prime candidate for medical school in Arkansas. Then came the new curveball: School officials told Boahene his foreign national status ruled him out, portending many months of intractable delay. Recovering from that shock, Boahene found a novel way to fill the time: He would stay in Arkansas for a graduate degree in chemistry. Yet at 26, he felt the years closing in.

Once Boahene had the chemistry degree in hand by 1997, Meharry Medical College in Nashville informed him he’d won a slot in their next class. He was in! But he had nearly starved trying to fund the graduate degree and wasn’t even close to affording the down payment for Meharry. As he tried to reckon with new life plans once again, a dejected Boahene was walking home from work when he bumped into a favored chemistry professor out for a jog.

“What’s up?” asked Jerry Manion, slowing up to catch his breath. “When are you moving to Nashville?”

“I can’t go,” Boahene answered. “I can’t get the money.”

Before Boahene could decline acceptance at Meharry, the professor was co-signing loan papers that would once again put Boahene on track. And he inveighed the would-be young doctor to make it count. “Do not disappoint me.”

Boahene delivered, graduating from Meharry in 1999 at age 30, at the top of his class of 120 newly minted medical doctors. Next up: a residency at the Mayo Clinic, followed by a yearlong fellowship in plastic surgery, followed by a term in Australia with a noted cranio-facial expert. Bursting with advanced training by 2004, Boahene’s seasoned network gave him entree to the vaunted medical institution he’d once considered beyond his reach, Johns Hopkins.

Today, Boahene’s career has hit a sweet spot. He’d always wanted to put his missionary zeal into action for the world’s most tormented populations. He now makes annual pilgrimages to Peru to reverse cleft palates in children born into poor families. He has made a special trip to Liberia, repairing the human damage from that country’s years of civil war. He has also taken on 20 surgical trainees in Ghana, sharing his skills with his home country of 20 million people. On his most recent visit there, Boahene found his trainees well on their way to independence. “They don’t need me anymore,” he smiles.

And it keeps going. Boahene’s department chair here approached his rising Ghanaian star with a proposition. “I want to establish some formal links with the hospital in Ghana,” said Lloyd Minor. “Can you make the link?”

Boahene could hardly have imagined a more ideal circumstance. “My career has been going round and round,” he smiles. “It’s not a straight path, but I think I’m where I’m supposed to be.” *


 

*****

No Going Back

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No Going Back
POST-SADDAM CAREER: Far from the forces that drove his family from Kuwait in 1990, Mohamad Allaf takes time out with fiancee Kendall Moseley (a fellow in endocrinology here) and their dog, Lily.

As the family car proceeded toward Kuwait’s airport just after midnight on August 2, 1990, 16-year-old Mohamad Allaf studied the night sky into which they’d take flight within minutes. He found himself marveling at the fighter jets storming through the air. He’d never noticed them before.

“This must be their training time,” Allaf’s father surmised. “If we were asleep now, we probably wouldn’t know about them.”

Young Mohamad, “Hamoudy” to family and friends, caught a trace of unease in his father’s voice. His father had been born and raised in war-torn Lebanon and had a good nose for trouble. But the Allafs had forged a comfortable life in Kuwait, known throughout the Middle East as a safe refuge for any hardworking emigre who could find a niche in the oil-rich emirate’s robust marketplace. The senior Allaf had earned such a life the tough way—rising from scrappy street vendor to managing partner in a stationers firm—and was now proudly steering his wife and four children toward their first visit to the new world, the United States.

By the time the Allafs were cleared for takeoff an hour later, the skies appeared dark but clear. When their British Airways flight lifted off the runway at 1:15 a.m., the family had no way of knowing they’d be the last civilian flight out of Kuwait before Saddam Hussein’s invading troops would seize the airport.

The bloody conflict that ensued set the Allafs adrift in a foreign land, cutting them off from any semblance of personal security. Looking back today, Hopkins urologist Allaf, who now goes by “Mo,” recalls with vivid clarity the moment when he really felt the earth give way from under him. It was within hours after landing at JFK airport, when Allaf’s father, Ezzedine, presented his hard-won credit card to an American hotel on that first night.

The hotel clerk withdrew a pair of scissors and sliced it in two. The seizure of his home country that day had rendered his bank accounts frozen. His credit card was no longer valid.

A stunned young Hamoudy watched as his father’s eternally sunny glow vanished in an instant. Gosh, he remembers thinking, we’re really in trouble here.

After a frenetic monthlong scramble that demanded creative negotiations with the cash value of their remaining air fares, the family called in favors and secured a small apartment in Philadelphia. While this gave them immediate access to the area’s public schools, a new form of hardship was just taking shape. The modest stopgap loan from a family friend was just a band-aid. The senior Allaf needed to venture back into war-wracked Kuwait to see if he could retrieve any assets, along with precious family photographs. He had to find out if he could rebuild a business.

At 16, Hamoudy was the oldest son. He spoke English well, while his mother struggled. For all intents and purposes, Hamoudy became the head of a very challenged household.

But as luck would have it, the struggling Allaf family’s apartment in the township of Lower Merion was situated right next to one of the most big-hearted neighbors one could hope for. Even now, nearly 20 years later, Allaf has a hard time talking about the woman who showed up at their doorstep unannounced, volunteering to help them adjust to a new landscape.

He pauses during a long interview at his Hopkins office. “This gets a little emotional,” Allaf says. He pauses again, collecting himself. “Wow.”

The neighbor was an American Israeli woman. Just months earlier, young Hamoudy had duly obeyed a school instructor’s orders to cross out the name “Israel” in his geography textbook to comply with a Kuwaiti decree stemming from the ongoing Arab-Israeli conflict.

Neighbor Zipora Roth paid no heed to the potential culture clash. “What do you need?” she asked, taking the Allafs under her wing to show them where to shop, how to navigate a private health system, which neighborhoods to avoid after sunset, and even explaining odd details of American culture that included offers in the mail telling the Allafs that they “May Have Already Won a Million Dollars!”

But even Roth’s generous guidance couldn’t protect the Allafs from an intensely difficult five years, without a sustaining level of income from the senior Allaf—or even his presence—for the entire period.

Describing his high school and early college years, Allaf understates the bleak realities. “I was not a free type of person,” he says. He tried to absorb family burdens while driving himself to achieve at every level of his education. “It was not a happy time for any of us.” Then the breaks began to come. An older sister graduated from college and found work. His mother had been assisting with public relations for a publishing house, and soon found a post with an international bookstore.

Through the slim window of his mother’s full-time employment, the family found opportunities to begin establishing U.S. citizenship. The young Hamoudy Allaf’s academic striving won his entry into Johns Hopkins University, which quickly became the springboard to a much bigger universe. He majored in biomedical engineering, exposing him to medical applications, which brought an introduction to famed urologist Patrick Walsh and Louis Kavoussi, a pioneer in minimally invasive surgery. Both of them mentored Allaf and inspired him with the possibilities of what he might achieve. In short order, Allaf entered medical school here, followed by invigorating residencies under general surgeon John Cameron and then back to Walsh.

With each new bending toward the grindstone of hard work, it seemed, an endless supply of new possibilities kept opening up for Mohamad Allaf.

By the time Allaf’s father finally abandoned Kuwait in disillusionment and rejoined his family in Philadelphia, fundamental realities had dramatically shifted. They were going to become Americans now. One by one, each member of the family scheduled an oath of citizenship. For Allaf, just asking for two days off presented an obstacle in itself. It came during his intern year, when all forms of personal time off were verboten. When he first summoned enough courage to ask, the chief resident didn’t even bother looking up: “Nope!” When Allaf re-gathered himself to explain why, she softened.

Allaf chuckles at his father’s emphatic embrace of his adopted country. In the basement of their Philadelphia home, he says, his father keeps what the younger Allaf calls “a shrine,” commemorating his own citizenship oath, including 20 framed photographs of the event, the most prized of which captures him sporting an American flag necktie.

Alongside the images in that revered gallery is a newspaper story depicting one of his son’s recent achievements in American medicine. Through a combination of his blended skill sets in biomedical engineering and urology, Allaf and transplant surgeon Robert Montgomery had performed the first successful trans-vaginal extraction of a transplantable kidney from a living donor. His procedure left no abdominal scars larger than a few small puncture spots.

But perhaps one of the most satisfying moments in the Allafs’ journey came just after Mo visited the family’s ancestral Lebanese village of Karak in 2006. Mo had just been hired as an assistant professor at Hopkins, and everyone in the village of several hundred souls seemed to know. Yet the new reality was slow to take root inside the mind of the then 32-year-old. When he entered his grandparents’ small living room for the first time since childhood, one of his relatives shouted from the kitchen: “The doctor is here!”

Allaf wheeled around to look back toward the front door in hopes of greeting this distinguished visitor, seeing no one. Then he caught himself. *


 
 
 
 
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