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Home > News and Publications > JHM Publications > Hopkins Medicine Magazine > Archives > Spring/Summer 2010
Archives - Being Father Teresa
Being Father Teresa
In the 23 years Rick Hodes has spent caring for indigent people in Ethiopia--adopting five children along the way--he has touched the lives of thousands.
Date: May 15, 2010
The 11-year-old boy felt paralyzed with fear. He had not eaten since his arrival at this mission in Addis Ababa the day before. He had spent most of the night lying awake on his cot, crying. When daylight arrived and he saw the mission’s front gate left ajar, he thought of making a run for it. He would sooner risk getting hit by one of the cars whizzing by than to stay another night in this place of dying people.
The boy, who called himself “Sem,” had fled his village in the belief that his grotesquely misshapen back would forever prevent him from assisting in caring for his family’s farm animals. When he arrived in Addis he was delivered to a university hospital, sleeping on a hallway bench while taking medicine for his diseased spine. He was later discharged into the dizzying throng of Ethiopia’s largest city, not knowing where to turn. When a driver offered to deliver him to Mother Teresa’s mission to stay, it sounded like a safe haven.
But from what Sem could see now, this was no refuge. It was a place to die. He was suspicious of everyone. When an oddly pale-skinned man approached him, Sem braced. Then the man gently sat down on Sem’s cot, took his hand in his and asked in Sem’s native language: “Tena yesteling, simih man new?” Hello. What’s your name? As Sem answered, the man drew him into a playful series of questions.
Softening, Sem allowed the man to examine his wildly crooked spine. While doing so, the man said he knew of other children dealing with major illness. He asked Sem if he and another sick mission boy wanted to go meet them.
When the boys got to the destination on the Addis outskirts, Sem was surprised to learn one of the kids there came from his own region. Three appeared to have some illness, with one sharing the same spinal deformity that tormented Sem and his mission friend. The regular boys there played table games. They cooked and ate. They seemed to like each other. They also seemed to like the man whom Sem came to know as “Doctor Rick.”
As events would unfold in the coming months, Sem would also begin calling the man “Dad.”
“I just like to help people,” says Rick Hodes, as if those simple words could explain such a dramatic life at the extreme edge of modern medicine, one that has seen him ministering to critically ill people for endless days in sprawling refugee camps; or helping to return thousands of forgotten Ethiopian Jews to Israel; or serving in a string of self-started clinics both in Addis and Gondar; or patrolling smaller Ethiopian villages to administer medicine on the fly; or setting up a self-styled global network that brings him cheap medicines from India and surgical referrals to the U.S. and neighboring Ghana; or in serving as the sole Western consultant for Mother Teresa’s mission in Addis, where—despite his open observance of his Jewish faith—he is sometimes called “Father Teresa.”
And, as if he needed something else to do in his spare time, Hodes launched a journey into adoptive fatherhood over the past decade. In his steady search for funding to support the medical needs of the sick orphans who filled his home, Hodes has legally adopted five of them, the maximum allowed by Ethiopian law. The arrangement puts them on Hodes’ insurance plan, which helps pave the way for the advanced procedures that have saved many of their lives.
It was the boys with life-threatening heart problems, or the severe spinal deformities, like Sem, who most needed the advanced care. The spinal condition is a form of spinal tuberculosis that particularly ravages many Ethiopian people, progressively collapsing their vertebrae until the entire rib cage becomes incapable of supporting heart and lung function. Few with the condition live into adulthood.
But commonly available drugs can arrest the disease process, and Hodes has cultivated relationships with a handful of surgeons beyond Ethiopia who have developed ways to straighten the crumpled vertebrae.
For Hodes, the leap to adoption took some thinking. And prayer. He was well into his 40s when the idea first presented itself. He had hoped to find a wife and to raise their own children, but what Jewish girl would want a life like this? He cared about these kids, and they him. His primary motive was to get them surgery, but adoption was for keeps. Hodes spent an entire weekend in meditation over the question before his internal voice sounded off: God is giving you this opportunity to help these people, he thought. Don’t say no.
“I love being a dad now,” he says, “and they seem to love being my kids.” The Hodes family now occupies three modest ranch-style buildings, with other assorted kids—nearly all orphans with serious medical conditions—blending in seamlessly around the core family in a variably sized group that sometimes pushes the boundaries beyond two dozen.
Visitors have come to marvel at the way Hodes maintains his tireless, life-sustaining mission while engineering a growing number of medical fixes in an ever-widening network. All the while, his sprawling brood has developed its own forms of independence, with older children cooking for younger ones and helping them with homework.
Within the last few years, the oldest Hodes boys have begun attending American schools. Tenth-grader Dejene attends a Hebrew academy in North Carolina. Sem is pursuing chemistry as a college freshman in Indiana, and Addisu is a 12th-grader sorting through college acceptance offers.
“I’m working with very sick people,” says Hodes. “I don’t have to worry about lawyers and I don’t have to worry about HIPAA. I can just be a doctor.”
Perhaps naturally, then, the Hodes approach to global health is getting wider notice. He came to the attention of the people behind CNN’s Heroes program in 2007—after Sem wrote an unsolicited testimonial to the program’s producers—and he’s been celebrated in other media venues before and since.
Now Hodes’ story is cresting again, this time in a stirring HBO documentary that aired in April, Susan Cohn Rockefeller’s Making the Crooked Straight, followed by the spring launch of a new book that movingly encapsulates his personal journey, This Is a Soul, by Marilyn Berger.
In his more extended profiles over the years, Hodes invariably lays claim to some of the Johns Hopkins DNA. And, just as invariably, it seems, Hopkins figures lay claim to Hodes.
“The qualities that people see in Rick Hodes today were very much alive when he was here,” says Randy Barker, a professor in medicine here who mentored Hodes during his residency at Bayview, then known as City Hospital.
“One of the most selfless men I’ve ever met,” says Shale Stiller, a trustee of Hopkins Hospital who made the pilgrimage to Addis for other charitable work and became mesmerized at the sight of Hodes, who “was treating every contortion of the human body.” Stiller visited a remote Ethiopian village with Hodes, taken with the way people spotted the doctor from a quarter mile away and began swarming. Before Stiller knew it, he and his wife, retired Baltimore jurist Ellen Heller, were assisting in deworming some of the village kids.
Stiller isn’t shy of comparing Hodes to historical spiritual figures like Mahatma Gandhi. “Rick,” Stiller says, “has a higher calling.”
One of Rick Hodes’ most oft-told episodes at Hopkins stems from a rotation in the Emergency Department in October 1984, when he admitted an 18-year-old man suffering from heart failure and pulmonary edema. A senior administrator learned of the admission and bridled at the young resident: “Why was this patient not screened for insurance?”
Hodes bridled back the next day. “Sir,” he wrote in a letter addressed to the administrator, “yesterday you pointed out to me, ‘We are not running a charity ward here,’ and said there would be a lot of talking before this will happen again. Is it now our policy to only admit sick patients who are fully insured? Would you take responsibility for sending this patient out of the ER?”
Hodes posted the letter on bulletin boards throughout the hospital and copied it to four senior physicians, who universally backed him up. The administrator went on to become a senior executive in a health financing concern. Hodes’ medical supervisor at the time, Randy Barker, later submitted the letter in support of Hodes’ nomination for mastership in the American College of Physicians.
Such encounters have given Hodes a curious take on all of the caterwauling that has seemingly infected every level of the American health system. While he likes the wealth of medical knowledge the West has amassed and prizes his access to its best medicines, technologies, and specialists, he has come to feel sorry for many of his colleagues. And, perhaps oddly, many of them have come to envy him.
“They realize that I’m working at a very pure level,” Hodes says, catching his breath while briskly hiking through the nighttime streets of Gondar, a city of 140,000 where he tends to one of his clinical outposts. “I’m working with very sick people. I don’t have to worry about lawyers and I don’t have to worry about HIPAA. I can just be a doctor. You really don’t need great technology to save a lot of people.”
As an example, Hodes describes his careful use of resources to treat some of his cancer patients. He deploys generic medicines from India in a multi-drug chemotherapy regimen that he once administered to two young men simultaneously in a bed on his home’s front porch, using low-tech intravenous drips tethered to the home’s drainpipe. Or there’s the recent case in which he was able to cure a 6-year-old with Hodgkins lymphoma with a so-called “ABVD” regimen that cost him $800 in Addis. “That would have cost you $60,000 in Baltimore,” he says.
This “pure level” of medicine is captured neatly about midway through Rockefeller’s Making the Crooked Straight (the title is a reference to Hodes’ focus on fixing the backs of the kids with spinal tuberculosis), where Hodes is seen in a spontaneous act of on-the-fly doctoring in a narrow stone alleyway. His patient is a 60-ish Ethiopian man draped in cotton clothes, who easily responds to the diminutive doctor’s offer to assess an apparent eye condition.
With the flick of a wrist, Hodes withdraws his car key and uses its tine to gently flip up the patient’s right eyelid, exposing the telltale evidence that he suffers from the prevalent trachoma that, if allowed to fester unabated, would consign the man to his country’s chronically high population of blind people. In the next instant, Hodes reaches into his red backpack. He fishes out four capsules of azithromycin, which he gets in bulk from a supplier in India. The man ingests the capsules on the spot, then washes them down with a few gulps of water from Hodes’ ever-ready liter bottle.
Hodes tells the man how to cheaply maintain his eyesight for the rest of his natural days.
“These people have no idea who I am,” Hodes says. “To them, I’m just a relatively well-dressed white guy who must know something. I offer medicine and they believe me.”
Contrast this with a moment when Hodes recently found himself on the receiving end of treatment in the West. He’d gotten some abnormal results on one of his own blood tests from a lab in Ethiopia. The data worried him, so he brought them along on one of his trips back to the U.S. He passed the results across the counter of an internist in New York. The internist looked up, smiled briefly, and then turned his back to Hodes.
“Well, let’s open up a file,” the internist said, turning to a computer keyboard and rattling off a series of questions about Hodes’ insurance, place of business, Social Security number, recent addresses, etc.
“I felt like a wall had just been thrown up,” says Hodes.
“I felt like I was applying for a mortgage.”
Hodes doesn’t know how to sweep away the American system’s clutter, but he does know how to treat some of the world’s neediest people in the most efficient manner possible. He also knows something about how to show young people that paths like his can be deeply rewarding.
“What he does is a very private thing,” says Abraham Verghese of Hodes. “He’s not about building an empire. This is about a contract between him and God, his calling.”
In that spirit, Hodes sometimes allows himself a moment of proselytizing. He tells the story of an impromptu airport moment in 2004, when he spotted a young man in a Hopkins sweatshirt. Hodes soon learned he was a freshman at Hopkins, majoring in public health.
“Well, I do that,” said Hodes. “In fact, I have some pictures I can show you.” In seconds, he had opened his laptop and was scrolling through photographs of sick Ethiopian orphans. In those chance minutes in a Detroit airport lounge, Omaha-born student Rishi Mediratta took special note of the images of kids whose backs were contorted into unnatural curves, typically hunched out at mid-spine, as if they were frightened cats struggling to stand upright.
Hodes had dozens of such patients, he explained, and he felt privileged at the opportunity to help them.
After a two-year correspondence, Mediratta made his way to Addis Ababa to conduct a survey on diarrheal diseases. In that ramshackle airport on the edge of a capital city teeming with 3.4 million souls, Mediratta asked a stranger if he could borrow his cell phone for a local phone call.
“I need to call a Dr. Hodes,” Mediratta explained.
“I know exactly who that is,” said the airport stranger. “He treated my son.”
While Hodes finds great satisfaction in sharing his view with other emerging physicians, he knows his life is not for everybody. He, after all, enjoys the unusual support of the American Jewish Joint Distribution Committee, which initially funded his deployment to aid in the exodus of 60,000 Ethiopian Jews to Israel and then opted to continue funding his work with the broader population.
Many students have visited his latter-day operation, and their life paths can hardly remain unaffected by their time in Hodes’ world. Visits include Hodes’ weekly all-faiths Shabbat ceremony with the kids gathered around, most of them Christian, several of them Muslim, all of them harmonious. Mediratta attended such ceremonies during his multiple visits to Addis. The net effect has deepened Mediratta’s commitment to a life in medicine, which he is now expanding beyond his degree in public health to pursue an MD and even broader programmatic approaches to serving the poor. “Doctor Hodes has had a huge impact on my development,” says Mediratta. “My trajectory would have been completely different. I guess he just came along at the right time.”
“What he does is a very private thing, in a sense,” says Abraham Verghese, who was born and raised in Ethiopia before fleeing the civil war there in the 1970s. “He’s not building an empire,” says Verghese. “This is about a contract between him and God, his calling.”
Verghese, who went on to become an American physician and now serves as a senior professor at Stanford, finds it ironic that he has been able to forge a relationship with this Western doctor who has gone in the opposite direction. Too often, says Verghese, idealistic young doctors pursue such far-flung ventures as a form of “medical tourism. You know, ‘I’ll do my little thing in Ethiopia, South America, whatever.’ For most of us it’s just a picture. For him, it’s real.”
It’s not an easy reality, of course. One of his constant challenges is cases where he sponsors a particularly needy patient’s trip abroad for specialized care, sometimes funding the trips with bits of his own JDC salary. Such events require a medical visa, and Hodes must sign a good-faith declaration that these patients will return to Ethiopia as soon as their restored health allows it. Despite their emphatic agreements to comply, some patients never come back. This thins Hodes’ credibility with the U.S. consulate.
But Hodes works hard to make sure such disappointments don’t impede his work, which sometimes appears to occupy his every waking hour. With nothing but a cell phone on the road and a dial-up modem from his home, Hodes contacts experts from around the world and even supplies essential X-rays and digital photographs of patients. He usually finds busy experts in his network are hungry to help.
Hodes’ constant personal industry looks daunting even from afar, almost superhuman. “I’m sort of blessed in that I don’t need a lot of sleep,” says Hodes, who is unusually generous with invitations to call him any time of the day. “Everyone else does,” he writes in an email. “You can, too.”
Family members have testified that Hodes seemed self-propelled from his early teens on, when his spiritual yearnings drew him to ride his bicycle to weekly Quaker meetings. He even sampled his share of Christmas masses over the years, and found it perfectly natural to make his own pilgrimage to Mother Teresa’s original base of operations in Calcutta, where—moments after setting foot on the premises—he was directed to feed porridge to a dying patient. He later attended Christmas mass with Mother Teresa and her fellow nuns.
Hodes enjoyed two other hands-on encounters with Mother Teresa before her passing in 1997, at one point sharing duties with the Catholic nun during her response to the Ethiopian famine. “You don’t chit-chat with her,” he recalls. “She was calm and focused and to the point. She typically said ‘acha’ (I see),” before shifting directly into action.
Though Hodes himself might resist direct comparisons to a person he views as “a saint,” his full immersion approach to saving lives teetering on the precipice has gathered its own apostles. There are the matriculating doctors whose lives he’s touched. And, it appears, some of his adherents may now be growing within his own household. With the sudden access to advanced education, more than one of his children has expressed an interest in becoming a doctor.
For grateful son Sem Hodes, a growing interest in chemistry might provide a gateway into a life of service. But for the time being, he has had to adapt to the tremendous distance between Indiana and his family’s home in Addis—even if eight of his brothers hold slots on Sem’s robust Facebook friend list of nearly 300.
“I miss them,” he says.