Roger Gollub, a model for leadership in public health

Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto  statue in downtown Anchorage.
Dr. Roger Gollub and his beloved golden retriever, Sophie, at the famous Balto statue in downtown Anchorage.

Five years ago today, on a cold Alaska night, I was awoken by a strange phone call left on my answering machine saying something had happened to my Anchorage friend, Dr. Roger Gollub. Confused, I called the emergency room at the Maniilaq Health Center in Kotzebue, a remote bush city in the Northwest Arctic Borough, 26 miles north of the Arctic Circle on the Chukchi Sea. Roger had flown there a day earlier on assignment—I was with him the night before. I could not believe what I heard. The medical personnel told me, with great difficulty, that one of county’s finest pediatricians and public health caregivers had died from injuries sustained on a trail just outside of town that night.

Dr. Roger Gollub, a career pediatrician with the U.S.  Public Health Service’s Indian Health Service, never returned home from his short visit to care for patients in this mostly Native community. He, along with a coworker, were mushing on a shared-use trail in subzero weather, under Alaska’s majestic starry skies, when they were run over by a snowmachine. The driver had a criminal background and was under the influence of drugs and booze. It was about a senseless a crime as I could have ever imagined, and more brutal because of the injuries Roger and his coworker sustained. (Note, Roger’s colleague survived, but only after heroic procedures and months of recovery, all costing more than any non-wealthy person can afford.)

After a bitter scream of disbelief upon hearing the news, I caught myself and thought, what would Roger do. I then spring into action for the next 24 turbulent hours, and the years beyond. In fact, my response to Roger’s tragic passing continues to this day. I would never have gone back to graduate school and earned my MPH in 2012 had I not been inspired by Roger’s amazing life’s work. He remains the finest man I have ever known.

Roger Gollub's good friend and champion in so many uncountable ways, Gunnar Knapp, stands by spot where Roger was taken. Thanks, Gunnar, for sharing this with all of us who cared about Roger.
Roger Gollub’s good friend and champion in so many uncountable ways, Gunnar Knapp, stands by the spot where Roger was taken on Nov. 19, 2008. Thanks, Gunnar, for sharing this with all of us who cared about Roger.

Roger had just retired from a distinguished career, which included an epidemiological residence with the U.S. Centers for Disease Control and path-breaking work with Native American and Alaskan Native communities (details here). He was still working under contract serving his many patients, and thinking about an active life ahead, including research, time with his wife and two daughters, projects with the Anchorage Amateur Radio Club, and travels he long delayed. Roger’s death forever changed my life, but also in a good way. From that time on I vowed to work even harder at showing the type of leadership that Roger demonstrated throughout his life.

Though he was only 5’6”, Roger towered above his peers as a professional, and particularly as an exemplary caregiver who understood his young Native American and Alaskan Native patients and their families. He was named physician of the year by the national health agency he dedicated his life too. He had legions of fans across the U.S. Public Health Service who held him in the highest of regards.

At Roger Gollub's "Celebration of Life," hundreds of well-wishers offered condolences and happy memories of one of Alaska's finest doctors ever (December 2008).
At Roger Gollub’s “Celebration of Life,” hundreds of well-wishers offered condolences and happy memories of one of Alaska’s finest doctors ever (December 2008).

I saw hardened, even stoic and cantankerous men who knew him through his ham radio activities openly weep when trying to make sense of his death. (Roger was an advanced ham, who knew Morse code, and who brought amazing life into the local club.) I saw more than 500 mostly Alaskan Natives give him the highest honors normally bestowed only to revered elders. I heard dozens of stories describing how Roger helped and even saved their very sick children, all while preventing costly medical waste within a sometimes-inefficient bureaucratic health delivery system. That alone is amazing, and Roger never expressed cynicism about that system that often thwarted him and his seasoned colleagues.

This letter, published in the Anchorage Daily News shortly after his death, captured a sentiment that lit up the blog coverage of his passing, with comments pouring in nationwide: “I am sure I’m not the only one who feels a great loss with the recent passing of Dr. Roger Gollub. He was truly a man with a servant’s heart and had a tremendous impact on my family. As a pediatrician at the Alaska Native Medical Center, he has shown pure dedication to the Native community and loved each and every patient. He had a place in my heart and my children’s. Once, my daughter had to see another doctor while he was on vacation, and cried for her doctor to come back. The world will never see another with the same compassion, dedication, intellect, integrity and valor as he. I was privileged to know this man for six years and he will never be forgotten in my children’s heart and mine. Linda Tomaganuk Anchorage.”

On the darkest of days, Roger still managed to smile. He always took phone calls from worried parents–at home, in his car, on his walks, wherever. How many doctors take house calls, or personal calls, ever? That was Roger. That was the kind of leader he was. He breathed it. He lived it.

Roger demonstrated to me examples of the leadership that I admire most:

Emotional Intelligence: Roger demonstrated this trait that most researchers say is the best predictor of leadership. He never appeared flustered. His coworkers described his ability to bring chaotic situations under control, in hospital wards or during infectious disease outbreaks, with a calm, deliberative, thorough, and positive manner. It proved contagious, and he earned trust and credibility among his peers.

Understanding of and Respect from his Peers: Abraham Lincoln, America’s greatest politician, was infamous for his empathy and his ability to understand his friends and opponents, which helped him articulate decisions and policy choices that always seemed perfectly suited for the difficult challenges ahead. He knew where the audience was, and where he needed them to go. Roger was celebrated in the Indian Health Service for his true commitment to community based participatory research, for which he earned the deepest respect from his Native American medical professionals. Mention Roger to anyone who has worked in this community, and you will quickly learn of Roger’s deep and genuine appreciation for the community he served during his lifetime. I met a former career pediatrician in the Indian Health Service last spring and mentioned Roger’s name, and was greeted by the most contagious grin I had seen in months. One University of Washington School of Public Health faculty member, who specializes in the field of community based participatory research and who knew Roger in New Mexico, said unequivocally, “Roger was the real deal.”

Leading by Example: Dorris Kearns Goodwin’s portrayal of Lincoln’s wartime cabinet, his famous “team of rivals,” highlights Lincoln’s eventual winning over of Democrat Edward Stanton. Before the Civil War, the former Ohio attorney had ridiculed and mocked the then lesser-known Illinois lawyer as a “long-armed ape” during a legal case during which Stanton shunned Lincoln’s work. Lincoln did not hold a grudge, and he then sought out Stanton to run the War Department during the Civil War, because he had the right qualities to master a complex organization. Stanton later become Lincoln’s strongest ally. Lincoln’s ability to put aside personal grudges and genuinely collaborate even with his political rivals was not an act. It was genuine.

Roger treated everyone he interacted with, even those who did not return the courtesy, with respect. I never once heard him utter a bitter word or even cynical comments, even when I expected them. I have met few people who have demonstrated this trait. Roger had a work ethic paralleled by few. He put in 12-hour days and longer, never compromised his duties as a father or husband, and excelled at nearly anything he tried to do—medicine, engineering, ham radio communications, running, parenting, research, epidemiology, research. Roger adopted practices seeing patients that saved taxpayers tens of thousands of dollars, which his peers steadfastly noted at his funeral. He never sought glory, though during his life he was gaining a national reputation he could never even imagine.

That tiny little guy you see in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).
The small guy in the front row, in the middle, is team captain Roger Gollub (University City Senior High School Track Team, 1973).

Roger  particularly demonstrated this talent at University City High School, where he ran track and cross country. I attended the same high school, though ten years after Roger. Roger was the smallest man on an interracial track team, which was comprised of very large young men who towered over Roger. Racial tensions were real here, but so were the strong bonds. I know this school, and I can assure you this is a serious alpha dog environment and not for the faint of heart, particularly among young, competitive men. Roger’s peers voted him captain of the track team, because he pushed the bar farther and competed harder and ran faster than all of them. In short, he inspired them to do better. He never asked for that title. He earned it. He made his team a genuine competitor at the state level. Roger carried that excellence to Yale where he competed for the Yale track team as well. (Roger’s own running hero was Olympian Edwin Moses.)

Moral Vision and Visionary: Roger’s values were nurtured in his Jewish, middle-class upbringing in a diverse community, University City, Mo., which we both called home. (I lived next door to Roger, but only briefly overlapped when I was younger, as he was 10 years older.) It was an often-hard place to learn about racial differences, but also a great place to dream big about pursing a path that made a difference. Roger knew exactly who he was and what he wanted. He graduated class valedictorian in 1973, and never forgot his roots. His vision was, as his friends said, a mix of Mighty Mouse heroism mixed with the Star Trek prime directive to do no harm–and yes, these describe his actions and values as a doctor working cross-culturally.

At Roger Gollub's celebration of life, his family assembled assorted "tools of the trade" he used to care for sick kids, and of course the famous lobster hat.
At Roger Gollub’s celebration of life, his family assembled assorted “tools of the trade” he used to care for sick kids, and of course the famous lobster hat.

I never once saw Roger lose faith in others or in the inherent goodness of people. His service to patients, the core mission of the U.S. Public Health Service, and purposes far bigger than himself can be seen in every personal and professional choice he ever made. He demonstrated and articulated a clear, humane vision for health care, community, family, race relations, and society that he blazed intensely everyday, inspiring dozens if not hundreds by his example.

Don’t be fooled by that doctor you see in this picture with a goofy grin, and a lobster hat and Elmo toys. That was a master professional’s slight of hand to get nervous kids comfortable and the most conniving of change agent’s subversive and effective strategy to reform a health care system that has long forgotten how to put compassion ahead of egos and profits.

I have yet to meet anyone in the field of public health and public service who embodied all of the leadership traits Roger seemed to have in spades. Sometimes we just get dealt the right hand and can say, damn, I was lucky I had a chance to work with or know such a gifted, natural leader. Thanks, Roger!

Making the case for public schools, the highest-stakes poker game around

Recently I posted a link on my Facebook page to a Slate blog piece by Allison Benedikt: If you send your kid to private school, you are a bad person. It drew some negative feedback as well as a very positive response. Benedikt, who is a parent, provocatively suggests if you do this, you are “not bad like murderer bad—but bad like ruining-one-of-our-nation’s-most-essential-institutions-in-order-to-get-what’s-best-for-your-kid bad. So, pretty bad.”

Benedikt then goes on to argue that people who abandon public K-12 education undermine the foundations that make for a healthier, more democratic society. In defense of her seemingly provocative view, she claims that the bad things she did with bad kids during her public school days taught her more about life than reading Walt Whitman. In the end, she pleads with the middle-class moms and dads of the country reading her piece to go to bat for public schools in the most visceral way.

There’s a big public health story here too, but first, let me give some personal background and why this resonated profoundly with me.

How I endured then cherished my public school experience

I have friends who send/have sent their kids to private schools, and I do not think they are bad. But having attended K-12 public schools my formative years, I am very biased to Benedikt’s point of view. It’s my tribe, those public school grads. You might call me a bulldog on this point. My mother was a public school teacher as well, so I know the exhausting and harsh down sides from the perspective of such educators.

The most important things I learned about life are the ones I clawed together in that often chaotic petri dish, and at times it was chaos too. While I think many aspects of U.S. public schools truly stink, mainly the large mega schools and school systems that reward jocks and criminally fail to prevent abusive bullying of all stripes, I cannot deny the value of socializing in this publicly-funded mosh pit provides.

A seen from my graduating class of 1983 from University City Senior High School--yes I'm in there, bad hair and all.
A snapshot from my graduating class of 1983 from University City Senior High School; yes I’m in there, bad hair and all.

The system I attended til 1983 in University City,  next to St. Louis, was good (in some ways), but very divided in terms of who was on the fast track to say a great music college and who was on the fast track to say joining the armed forces. Both paths seem good to me now, and I was among those without a clear path. People came from respectable professional families (the ones whose parents were high-earning types like doctors) and from those living on the margins. The realities of race, and in my mind class, were omnipresent. During my years in that system, grades 3-12, the student population was roughly 70% black, 25% white, and 5% all other (Latino, Asian, Middle Eastern).

There were great teachers, and awful ones. There were clicks, stoners, nerds, punks, jocks, super achievers, motorheads (people I respected the most), future criminals, future drop-outs, future business people, musicians, and hip hop artists. Violence lurked in many places, too. I saw three extremely violent and criminal assaults (two on campus, one off) during a several-year stint. I experienced more than my fair share of racial harassment, and I was hospitalized after being cold cocked on a school setting—a crime I partially brought on myself, but also with racial undertones. But hey, who says high school is supposed to be walk through the flowers?

A group shot from my 1983 graduating class; I am not seen in this one.
A group shot from my 1983 graduating class; I am not seen in this one.

In the end, I would not trade this for anything. All of this gave me the tools to deal with an increasingly diverse country, where skills at communicating cross-culturally matter in every professional setting, and in most personal interactions too. In a more fundamental way, I felt equipped to stand my ground and hold my own anywhere in the world, and really appreciate people on their own terms. It gave me a window to really get to know people.

Schools becoming less diverse and more segregated

Today, however, it is more likely students finishing their K-12 education will not have experienced something like what I did—a school that has true racial and cultural diversity without deep segregation at the district level. According to a 2009 report by the University of California at Los Angeles’ Civil Rights Project, schools in the United States are more segregated today than they have been in more than 40 years. Worse, millions of non-white students are trapped in so-called “dropout factory” (public) high schools, where large numbers do not graduate and remain unprepared for the challenges of an increasingly knowledge-based economy of technological haves and have-nots.

While our nation has come a long way since the Brown v. Board of Education Supreme Court case of 1954 made it illegal to segregate schools based on race, there are still many problems. A typical example is in Richmond, Va., where a recent news report found that 40 years after the U.S. Supreme Court rejected consolidation of public school districts to achieve racial integration in the Richmond area, one in every three black students in the Richmond-Petersburg region attends a school with a population that is at least 90 percent black and 75 percent poor.

So what right-minded parent, black or white or brown, would want their child in a school that is segregated and all but likely underfunded? It is a non-starter, really.

School Enrollment comparison
The U.S. Department of Education’s data show private school enrollment has dropped, mostly due to declining attendance at Catholic schools.

Public vs. private schools by the numbers

According to the U.S. Department of Education in 2008, the number of public schools in the United States outnumbered private schools (including religious schools) by about a 5-1 margin (65,990  vs. 13,864). In the past 15 years (1995-2009), private school enrollment actually dropped from 12% of all enrollment to less than 10%. The main reason is attributed to the drop in Catholic school enrollment.

Economic downturns also led to falling enrollment. Due to the increasing decline of the U.S. middle class and the concentration of all wealth in the hands of a few Americans, the disparities have even worsened. Between 2009 and 2011, the mean net worth of the wealthiest 7% of households rose 28%, while the mean net worth of households in the lower 93% slipped 4%, according to a Pew Research Center.

According to Jack Jennings, founder and former president of the Center on Education Policy, the real issue remains how well the nation will educate the 90% majority—the ones with increasingly less wealth—who are not privileged and have less resources and who comprise the majority of our public school student population. They will be the future soldiers, medical professionals, politicians, scientists, engineers, construction workers, and more. “If we want a bright future, we must focus national attention on making public schools as good as they can be,” Jenning says.

At last count, about 49 million kids were enrolled in K-12 education, or nearly or a sixth of the U.S. population. So the debate about where we educate these youngest citizens and our up-and-coming leaders is about as important issue as any we face as a nation, and as citizens of our communities and country.

Jessica Strauss, in a June 2013 New York Times piece on the country’s growing education divide, pointedly notes: “The truth is that there are two very different education stories in America. The children of the wealthiest 10% or so do receive some of the best education in the world, and the quality keeps getting better. For most everyone else, this is not the case. America’s average standing in global education rankings has tumbled not because everyone is falling, but because of the country’s deep, still-widening achievement gap between socioeconomic groups.”school_choice

Education, health, and ethnic diversity–fused at the hip

So where should kids get the tools they need to prepare them for their life challenges, a turbulent economy that is divided by knowledge and technology, and the diversity in a country that will be less than 50% white by 2043. Navigating the nation’s ethnic and linguistic diversity will be as critical for someone running a small business as it will be for a highly trained medical professional serving patients with different ways of dealing with health care.

Research over the past 20 years has generated countless studies consistently showing how a person’s health is driven largely by underlying factors, or the social determinants of health. In short, one’s education will predict a child’s future health as good as any other causal factor.

So as a nation, if we also want to promote opportunities for everyone to achieve good health, as well as good jobs, there must be a public policy imperative to ensure that the poor, underachieving, increasingly non-white public schools do not get short-changed. Does that mean more blog posts and rants chastising liberal middle-class parents and taunting them? Perhaps that’s one way to raise awareness, as Benedikt tried and I think succeeded.

But I’m less convinced parents of any race who want their kids to be learning Mandarin by age 8 and making high-def feature movies by grade 10 (like students do at the elite Annie Wright School of Tacoma, Wash.) will dare risk their child’s well-being for the larger social good. If parents are fortunate to be economically well off in that narrowing minority of “haves,” they will choose the high-price, high-quality schools like this leafy campus and pay tens of thousands of dollars for that rare privilege. Because I am not a parent, I can avoid this very hard decision, so I am very lucky.

Such advantage-bestowed kids will undoubtedly go on to be successful leaders. But I am less inclined to believe they will be the right leaders, who have a visceral sense of what’s best for all of us, though many of them will be the ones driving the agenda in many of the organizations that impact us the most.