Post-Doctoral Fellow at CC Department of Bioethics Part of Academy Award-Nominated Documentary

Episode # 46
Uploaded: August 31, 2010
Running Time: 7:15

SCHMALFELDT: From the National Institutes of Health in Bethesda, Maryland, this is CLINICAL CENTER RADIO.

It's long been known that the Clinical Center at the National Institutes of Health attracts some of the finest people in the health care field from around the world. Such a person is Dr. Chiara Lepora, a native of Italy and a post-doctoral fellow in the Clinical Center's Department of Bioethics. Before coming to the Clinical Center, Dr. Lepora led a Doctors Without Borders mission in Monrovia, Liberia. Her experience with this internationally renowned medical/humanitarian organization was the subject of an Academy Award-nominated documentary titled, "Living in Emergency." Dr. Lepora talked to Maggie McGuire, editor of the Clinical Center News, about her experiences with organization.

LEPORA: My first mission was in Angola and it was just at the end of the 30-year-old civil war that Angola had. So we were the first team that was able to access areas that called gray zone, so it was the area between the two fighting factions that had no humanitarian access for ages. And it was really an interesting experience, surely shocking for us, to see the level of famine. There was a huge crisis, and the fact that people did not see a doctor for probably all of their life.

SCHMALFELDT: It was after her time in Angola that Dr. Lepora came to lead the organization's mission in the African nation of Liberia.

LEPORA: I’d been working as a field physician for two years and then I decided to do a master’s in tropical medicine and international health. I started working again with Doctors Without Borders, but more in a coordination position. That corresponds to somewhat being able to set up a program and manage it, not directly from a medical perspective but more in a broader way. Being able to evaluate the needs of a population, to adapt a program to those health needs, and to have the means necessary to run it, and provide the means necessary to all the medical teams that are coming, which comprises obviously the expatriate doctors, as I was before, but also a lot of nurses, the logisticians, the administrative staff, and especially, the biggest part is usually the national staff that participate in making sure the project can run.

SCHMALFELDT: Surrounded now by 21st Century, state-of-the-art medical equipment at the NIH Clinical Center, Dr. Lepora recalled what conditions were like inLiberia.

LEPORA: In Morovia, in the capital, as much as in the country, the whole medical system was completely disrupted by the war. And that includes surely structures like hospitals and the presence of drugs but especially the lack of health staff, because the majority of doctors who were in the country before, left the country during the war, or died in the war. So the amount of national staff, of doctors in Liberia, left when we were there was so limited that it was impossible for them to take care of the needs of the whole population, and those were really normal needs like you would have here: hypertension, appendicitis, obviously women having to deliver.

SCHMALFELDT: Were there ethical considerations involved in filming the patients in this documentary?

LEPORA: We really wondered whether, in a way, just the fact of asking, ‘Is it ok with you if the camera comes in?’ was enough. Maybe they don’t want the camera to be there just because they don’t know what it is. But at the same time, if it’s a doctor asking them they might think its important for the doctor and therefore its important for their medical care. So we’ve just tried to make sure that it was the film crew asking separately and it was made clear that it had nothing to do with the medical care happening.

SCHMALFELDT: So what made Dr. Lepora decide to leave Doctors Without Borders and come to work at the Clinical Center?

LEPORA: I started thinking about studying bioethics because I had way too many questions and not enough answers and I was suffering the fact of having to make decisions all the time without knowing if those decisions were right or wrong.

SCHMALFELDT: And what were some of those questions?

LEPORA: Probably one of the most common is the issue of resource allocation. Knowing that the needs of a population are just overwhelming compared to what you have. Having to make those types of choices has always been very difficult. And I think we tend to think the problem of resources is about money, for example, not having enough drugs or not having enough ventilators or things like that. In my experience, Doctors Without Borders is a well known medical organization, and it tended to avoid those type of problems, to make sure that drugs and materials and everything are commensurate to the needs. But still the problem was about human resources. Having only one doctor for 250 patients that need to be seen. It doesn’t matter how many drugs you have, you still have to make choices about who needs to be seen first and who needs to be sent home one more day, which are really heavy, heavy choices.

SCHMALFELDT: The documentary "Living in Emergency" is touring the country on an on-demand basis. Visit www.livinginemergency.com [disclaimer] for more information. And if you would like more information about the NIH CLinical Center or one of the 1,500 clinical trials and studies performed here, log on to http://clinicalcenter.nih.gov. From America's Clinical Research Hospital, this has been CLINICAL CENTER RADIO. In Bethesda, Maryland, I'm Bill Schmalfeldt at the National Institutes of Health, an agency of the United States Department of Health and Human Services.

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