Midd Moment, Ep. 7 with Jill Seaman ’74

Intro:                           It was a group of people right after Vietnam. We were going to show the world we could heal the world and we were determined to make that the best medical care in the world. We really, really worked hard at that.

LP:                               You’re listening to Midd Moment, a podcast of ideas from Middlebury’s leaders, independent thinkers who create community. I’m Laurie Patton, president of Middlebury and professor of religion.

My guest today is Dr. Jill Seaman, Class of 1974. Jill has split her time between two of the most remote and challenging spots on the planet, the Southwestern Alaska hub of Bethel, and South Sudan, a country recovering from decades of civil war. Since 1989 Jill has worked in South Sudan to cure the infectious disease, kala-azar, also known as black fever, which has devastated the Nuer people. In Alaska, Jill works for an Alaska native organization that runs a hospital and clinics for the Yupik people who suffer from historical trauma, from epidemics of disease brought by early missionaries, to the suppression of culture.

Jill has been recognized by Time magazine as one of its 10 heroes of medicine. Jill was a MacArthur Fellow and has collaborated with Doctors Without Borders and the World Health Organization on her projects in the South Sudan. We are honored to say at Middlebury College, Jill was awarded the Alumni Achievement Award.

Jill, thank you so much for joining me today in conversation. We are really honored and grateful to welcome you back to Middlebury. I think it would be fun to start out talking a little bit about Idaho. Can you share a story of a moment when you were growing up there where you knew you wanted to pursue medicine?

JS:                                You know, I came from a nuclear family, living in a small town, everybody knew each other. Actually, I think when I was a child, I knew that there were three possible professions for me. One would be being a doctor, one a farmer, and one a school teacher. I always imagined that I would come back to a rural community, farming community, and share my knowledge with the community I was in. So, things change when you grow up.

LP:                               Yes, but you did, in a way, almost exactly that at a certain level.

JS:                                Yes, I went to farming and fishing communities. Absolutely.

LP:                               Was there a moment when you knew that medicine was going to be the thing you chose rather than being a school teacher or a farmer?

JS:                                Well, I never thought I was tall enough to be a school teacher, so …

LP:                               They all were tall, right, right?

JS:                                Women weren’t farmers then, so that was going to be much more complicated. I don’t know, it just, it always was there with me, so I really can’t even explain it anymore.

LP:                               How did you find out about the villages that you now clearly spend so much time in and it becomes so much a part of your life?

JS:                                I went to the University of Washington School of Medicine, which meant that we really did get to go to places like Montana, Idaho, and Alaska to do our clerkships, and so I had gone to Alaska before. Once when I was in Ketchikan, the doctor there told me that if I wanted a place where the culture was still intact, but it was a lot, a lot, a lot of work, I should think about going to Bethel. When I was doing an internship and I decided I really, really didn’t like what I was doing, I called up Bethel, and of course needed a doctor and I went.

LP:                               Can you remember the day that you got there, what that was like, or your first weeks or months in Bethel?

JS:                                I remember my introduction, they would have one doctor try to introduce you so that you would feel comfortable coming, so he wrote me this beautiful postcard. It was a postcard that showed absolutely gorgeous field of wild flowers, alpine wildflowers and a mountain in the background. The first line on his note was, “This is not what Bethel looks like.” It was his way of welcoming me to Bethel.

But it was a group of people right after Vietnam or that we were going to show the world we could heal the world, and we were determined to make that the best medical care in the world. We really, really worked hard at that.

LP:                               What were the steps that you took initially to create that medical care?

JS:                                One of the things that Alaska has that the rest of the lower 48 does not have are community health workers. They take a training course that’s complaint-based medicine, and they learn how to deal with primary health care and they do it in the village. It’s really hard because of course lots of the patients are your relatives, but you also know the patients, so you know who has which problem. It brings medical care very, very, very close to people. It’s a shame we don’t have it all through the world, but it works so well in rural Alaska.

LP:                               You’re in Bethel, and you’re a new doc, and you’re really getting to know the people. Were there particular people that you worked with that really struck you as immediately talented?

JS:                                Everybody there was really working hard to make the system provide really, really good care. One of the unique things about Bethel is all the docs work together. There is no worry about someone taking someone else’s patients because we’re not fee for service and because we like to ask each other questions. I think that that makes it a much, much nicer place to work. And I think it’s probably better for the patients.

LP:                               I was curious, how do you think about indigenous health care and healing practices, and how have you integrated them into your practice or not?

JS:                                Let’s talk about South Sudan. I think when we got there, and I didn’t know the language, and I didn’t really know the culture, and none of us ever asked about the local healers, and it might’ve been a mistake in a way because it would have been nice to be able to give them some status in the treatment because we were actually the people that cured the disease. It wasn’t us, but it was the people that we trained. That changes the dynamic of what happens to them.

But I do have a nice story.

LP:                               Please.

JS:                                We are in the meningitis belt. In Leer, one of the first places I worked in South Sudan, there was a meningitis outbreak. They would send the truck down to the waterfront, and they would come back, and there’d be somebody dead in the truck because they were alive when they got in and they were dead by the time they got there. It was a very interesting time because we had already been bombed, and so people would come to us before 10:00, and then they would go away and they would come back after 4:00 because everybody knew that the Air Force of North Sudan had bankers’ hours.

This one little girl comes in and I do her lumbar puncture, and I do have an excuse for how I didn’t treat her immediately. It’s because I didn’t notice that the fluid was a little cloudy because I had conjunctivitis and I really couldn’t see it. I put it under the microscope. Oh my gosh, I thought, “Oh, I’ve got to find that child. She’s clearly sick. I should’ve just treated her right away.” I was so worried, so worried.

4:00 finally comes around, there she comes back, she’s still walking, I’m really happy, and I say, “Oh, I’m so sorry I delayed, but your child has meningitis. But I think she’ll do okay cause she’s still walking now, so we’ll start treatment right away.” I said, “But I’m so sorry.” They said, “Oh, you don’t have to be sorry. We knew she would live.” I said, “Oh, really?” “Yes, because you know the one that died over there, that was our son. He died, so this one, we took and we sacrificed a cow first, and then we came, so we knew it would work this time.” I said, “Oh, that was really good that you came right away afterwards.”

I was so surprised, I didn’t even know what to say. This was my first year there. But it’s really amazing how much traditional medicine actually still happens, even though you don’t know it. There’s a lot more that happens. That’s very complicated for me to understand and I have no problem with it. When people want to go away to get something, I say, “Yeah, but you do have a disease that I think that I have some medicine for it too, so I’d really like you to come back after you get that treatment. Let me just give you this now and then when you come back we can continue the medicine.” Everything works out fine. I am not sure how much direct physiologic health they got, but certainly if you’re more comfortable with what’s going on, you have a better chance to be well.

LP:                               We got the story of how you got to Bethel. Then take us to how you got to Sudan.

JS:                                I went to Trop Med School.

LP:                               Tropical Medicine.

JS:                                Tropical Medicine School in London. MSF came and was recruiting people that were getting trained there. They told me that they had a cross-border job for me available.

I get this job that’s cross-border, that I find out later is clandestine. I actually got the job thinking it was the first job I would go to, but I would probably find what I really liked later.

LP:                               What does it mean, you were saying it’s a clandestine health operation? Is that right?

JS:                                It was clandestine to even be there.

LP:                               To be there.

JS:                                We did not get permission from anybody but the rebels fighting the war told us it was okay and we’d tell everybody along the route that we were flying in, but the government of South Sudan did not officially know that we were there.

LP:                               That’s incredible. How long did you stay there, your initial first foray?

JS:                                I never left. I’ve been there ever since. Then I would come home for one month and work in Bethel just for one month.

LP:                               Now do you divide the time?

JS:                                Oh, yeah. We started our own program, so now I work. I need to earn money so I have to write thank-you letters to have people donate. I have to get all the paperwork done because I don’t have an administrator working for the project, so I need to come back and be in a place that’s easy to do that. If I tried to do that and take time off in South Sudan, that doesn’t work because there are people always at the door. It doesn’t matter. It doesn’t matter. Even if I say, “Please don’t come,” or I go to a different place than I’ve wanted, people come looking in windows of every place to try to find out where I am. I can’t get any time off unless I’m sick and lie down in a tent.

LP:                               How many people are in your clinic now to help you?

JS:                                Something like 35, something like that.

LP:                               Do you do a lot of teaching?

JS:                                When you have a horrible outbreak of kala-azar, you don’t have time to do the teaching. You need to do it when you don’t have that and you need to do it when you’re not doing another massive project because there is so many more people living there. With the displaced population that moved into our area because we have this oasis of peace around us, we now have 50,000 people where we used to have 5,000. So there’s a lot more people and so many more complicated patients. There is no more referral center. We can’t just send someone to a referral center.

I realized that many times in Africa, sending someone to a referral center makes you feel good because you got them more care, but in reality you didn’t get them more care because they’ll go there and the specialist won’t be there, or no one will see them or whatever. It’s not necessarily good to be able to refer someone to specialty care, but at least we used to have a place that would do basic surgeries. We don’t have that now. We have no place to send people. Then with the increased number of displaced, it’s a lot more work.

LP:                               Tell me a little bit more about the oasis of peace around you. Is that because of the clinic, do you think?

JS:                                Part of it is luck. There are no roads. No roads means no tanks, no tanks means people can make their own decisions.

When the civil war started, all of the head people in the military for the place where we work have said that Old Fangak has to remain for the healthcare people, and so we can’t station our battalions there. They have to be stationed away. We really have to try not to do too much shooting there because it scares people, it scares the patients and it scares anybody working. They’ve tried to keep it as a place where you can’t have major military functions. It isn’t always successful, but most of the time it is.

LP:                               That’s a wonderful example of a partnership. I also was learning a little bit about the Alaska Sudan Medical Project, which is also a really interesting and somewhat unlikely partnership between your two communities. Tell me a little bit about the story of how that partnership came about and how it’s thriving now.

JS:                                In the late 2000s Jack Hickel came to visit. He was also an Alaska doctor to come visit. He got there and when he left he said, “Jill, you need a building. You really need a building. You can’t do this without a building now. We’ll have to do something about it. I’m not promising anything, but we’ll have to do something about it.” He then started the Alaska Sudan Medical Project. I think it’s called Initiative now.

LP:                               These are all volunteers from Alaska who basically have come spending thousands and raising thousands to build these buildings.

JS:                                Alaskan doctors have already worked in the bush. Alaskan doctors aren’t scared of sleeping in tents, bats, mice, all these things are okay. They’re used to traveling, doctors that spend thousands buying their tickets over and bringing stuff that I need. I must say that when people see expatriates come, and then they see them go away and come back again, it is such a boost because they say, “Oh, they liked us. Okay, they’re coming back.” This whole idea that the world hasn’t forgotten you is really, really nice.

LP:                               Jill, you know, Middlebury is a language school in so many different ways. I’m wondering, you’ve been such an effective advocate, and healthcare worker and provider in places in the world that need it the most. What languages do you work in and what languages did you learn in order to be so effective?

JS:                                I am not a tribute to Middlebury’s language schools, I am very ashamed to say, but I can’t tell you at one point in my life I knew how to ask if you have diarrhea in eight different languages, which is not a very good conversational language skill. But in Africa, I speak a teeny bit of medical Juba Arabic and some medical Nuer, so I can carry on a conversation a little bit with the Nuer. I have a problem that several doctors have come across, because unless you’re forced to spend time with people, you feel like you’re forced to be more spending your time treating people than learning the language, which is really, really sad. I wished I had been taken away someplace where nobody knew I was a doctor and learned the language.

LP:                               Done the Middlebury immersion.

JS:                                Right.

LP:                               Juba Arabic, right? That’s right.

JS:                                Or Nuer.

LP:                               Well, there’s still time. You never know. Do you do work with translators then?

JS:                                I have a translator who is brilliant in Old Fangak. This translator, he is so good because he already knows everything I’m going to ask, he knows how I ask it. Our translation would not be easily followed by other people because I do speak a lot of the language and he does take initiative, but we have a very good working relationship.

LP:                               Oh, that’s wonderful. I actually misspoke earlier. I should have used the word interpreter because at Monterey we have a medical interpretation program. How did you find Middlebury from Idaho? Because you mentioned earlier that you might’ve been the first person from Idaho to come to Middlebury.

JS:                                Actually, I think I was the first person to come to Middlebury who graduated, who was from Idaho.

LP:                               Who graduated, from Idaho.

JS:                                Apparently there was someone earlier who didn’t stay.

LP:                               Who didn’t graduate. Right.

JS:                                That’s what the Dean of Women told me then, and Dean of Students told me then.

I have to tell you, when I got here, you have to understand that I was from a very conservative place. My parents may not have been conservative, but everybody around me was conservative, old-fashioned conservative, but conservative and very wary of East of the Rockies. I got here, and I looked around and I called my mom. Of course, I knew very well I would not call her collect. I had all the change I needed in my pocket. I called her and I said, “Mom, I don’t know if I can stay. I think they’re all hippies here.” My mom, bless her heart, said, “Well, Jill. Why don’t you stay there for a while. I bet you’ll find out it’s okay, so just stay there for a while. You can call me tomorrow too.” I survived getting here.

LP:                               You did. You did.

JS:                                It worked out okay.

LP:                               The thing I’m going to end with, we talked about in the car, which is the question that people live, right? What is the one question that you never know the answer to but you never get tired of asking?

JS:                                That is not the type of question that I can answer, but I can tell you a story. The story is that I was doing research on two drugs that were actually the same drug, one made in India, one made in England. The one in India was one-fifth the price of the drug made in England. Since it was to treat kala-azar, that huge epidemic where 50 percent of the population had died, and if you could get a cheaper drug, that would make a huge difference.

But I remember at nighttime I started wondering, “Well, what about the custodian at the plant that’s making this medicine in India? If he got kala-azar, would he be able to afford the treatment? I don’t know, but I know the person who is custodian in England would be able to access care because he’s British and has the National Health Service.” I started thinking about that and then I realized, “This is too complicated. This is too complicated. I cannot deal with it. I will just continue and focus on what I know I can do.”

LP:                               Well, what you have focused on, what you know you can do has really been world changing for so many people. You’ve been a model for rural healthcare workers around the world. Thanks for coming back for your Reunion and we love having you here. I am now going to have to share you with a lot of others of your classmates who want to spend time with you. Congratulations and thanks again.

JS:                                Thank you very much. I’m really honored.

Hi, this is Erin Davis, producer of the show. Midd Moment is produced by myself and Juliette Luini, Class of ‘18.5, with help from Chris Spencer. If you have a Midd Moment to share, a time when things came together in a particularly Middlebury way, share your memory on social media using hashtag #middmoment, or record a voice memo and email it to us at middmoment@middlebury.edu. We’d love to include your Midd Moment in a future episode of the show. For more conversations like this, subscribe to Midd Moment on Apple Podcasts or wherever you get your podcasts. Thank you for listening.