Mission to Africa: physician executive faces Third-World perils bringing first-rate care to Africa.

IN THIS ARTICLE ...

Learn how an ACPE member copes with the stresses and successes of mission work in Africa, bringing health care, drinkable and community leadership to the poor.

Ephraim Palmero, MD, steered his white Toyota 4x4 toward the military checkpoint outside of Monrovia, Liberia, and waited for the guards to wave him through the gate. His four-year-old son sat in the back seat, while a medical administrator rode shotgun.

Encountering checkpoints in a country, turned war zone is routine for Palmero and a decal affixed to the front of his track guaranteed safe and swift passage. This time, though, the guards asked Palmero to step outside of his truck. The doctor hesitated, and immediately one of the guards lifted an AK 47 and moved it within inches of his ear. "I was really scared," Palmero says.

It was not the first time.

In a separate incident, a militiaman, all of 13 or 14 years old, shoved an automatic rifle into Palmero's face because he thought the doctor should direct his attention to a different triage patient.

Another boy once threatened to kill him after he sutured his gaping wounds. And in another run in with a crazed gunman, a guard hit Palmero's windshield with the butt of an assault rifle for no apparent reason.

Palmero, 35 and a father of two, experienced this treatment after agreeing in 2000 to be the medical director of the Seventh-day Adventist Cooper Hospital in Monrovia.

By the time the guard at the checkpoint had introduced Palmero to his AK-47, the Filipino doctor already had decided Liberia's politics made it far too difficult to practice medicine in the country.

"I was just too nervous." he says. "It was time to get out."

More than a year later, the experience lingered in his mind as more unrest surfaced in Liberia. It reminded him of the time then President Charles Taylor was threatened by rebels in May 2002, forcing Palmero and countless others to flee the country. Palmero and his family went to the Ivory Coast. Later, he decided to go to Gambia, where he is now the country's health care director.

Doctor duties

His current title is far too simple for what amounts to a complex job. He represents the Adventist Development and Relief Agency International, or ADRA, a humanitarian organization established in 1984 by the Seventh day Adventist Church to provide disaster relief to individuals and communities.

Palmero is a local spokesman of sorts, meeting with local and national leaders, as well as the media. He manages and monitors development of relief efforts in the country, oversees emergency food supplies during crop failure and helps install running water in communities.

On top of those duties, he serves as the director of the West Africa Union Mission, a health ministry. That job is mostly administrative as he provides guidelines and monitors Seventh-day Adventist hospitals in Liberia. Sierra Leone and Gambia.

The positions, though, come with an intriguing set of circumstances. Palmero is charged with operating religious-based services in some countries where the majority of the people are Muslim.

Electricity powers on and off so much that most people rely solely on cellular phones for communication. And danger is a reality. Even at the six-bedroom home Palmero shares with his wife and two sons, ages 4 and 2, there is one security officer stationed inside and outside the house 24 hours a day.

Lifelong calling

The work is a lifelong calling for Palmero. He was exposed to the life of missionaries at a young age. His father was a minister and a Seventh-day Adventist mission president, his mother an elementary school teacher.

When Palmero was a kid in the Philippines, his parents opened their home to doctors on medical missions. The teams of doctors who stayed under his parents' roof motivated the impressionable youngster. He talked with them and noticed they possessed jovial spirits and were well-traveled.

They also had luxuries others couldn't afford: sprawling homes, fine cars and anything else they wanted. Still, it was his grandfather who nudged Palmero toward medicine. Palmero earned a bachelor's degree in biology in 1988 and worked for a short time as a model.

Aggravated, his grandfather took him aside one day and told him to stop wasting time. He told him to go to medical school. If he did, Palmero's grandfather promised to pay his tuition. Palmero accepted the offer and headed to Angeles University College of Medicine. He graduated in 1993.

African adventure

While an intern at a medical center in Manila, Palmero met a female doctor with an adventurous spirit. They married in 1998. Securing positions as doctors in the Philippines meant they laced stiff competition for jobs. The hot, sticky climate and congestion also didn't suit the couple.

So two years later, Palmero and his wife, a pediatrician, moved to Africa where they both worked in Monrovia. Today, they are raising two children they describe as rowdy. "They don't have any government," Palmero jokes.

Palmero's call to serve SDA Cooper Hospital was a laboratory test for a physician executive in the midst of a war. The demands of the job included:

* Reviewing financial statements knowing the government's account would not be settled

* Working with security officers who ran away from armed militiamen

* Tending to patients who reeked of opium

The benefits trump some of the danger. Palmero doesn't pay taxes or medical malpractice premiums. He has a stall who works for him at his home, including a cook, gardener and a nanny for his children.

And he is not confined to a clinical practice.

Palmero meets with contractors for water projects, contributes to health care planning and roams file African countryside in a 4x4 equipped with a satellite phone. He spends little time in his home office and is often found navigating crocodile-infested water, helping feed refugees or providing fortified meals to malnourished schoolchildren who greet him with distended stomachs.

"This road, which I took, can be less traveled compared to those making $300,000 a year," he says, "but I felt so honored for the chance of putting a fortified meal in the bowl of a starving child too weak to smile."

Most of his patients are women and children, mainly because men are more respected and have better access to food. As a result, women, who farm and take care of the children are more vulnerable to illnesses such as malaria, typhoid, HIV and parasites.

The complexities of social and economic issues provide Palmero with opportunities few doctors face. "I'm more than a physician," Palmero says. "I don't treat a patient; I treat a village."

Many hats

Disaster relief work knows few boundaries. One moment, he is a liaison; the next, he is a reporter. Soliciting funding and implementing projects require a lot of time, and the job demands a leader who is flexible and willing to learn.

Palmero has given PowerPoint[R] presentations in villages using car batteries for power, shipped heavy equipment and cleared relief goods through customs. He counts among his many talents the ability to help install water pumps, solar panels and windmills and can repair anything from digital satellite receivers to computer networks using solar energy.

Even his driving repertoire is impressive. He is adept at operating a dump truck, pay loader, backhoe and even a crane. "It's an adventure," he says. "I'm enjoying it because I see a different world view."

Some, including a few members of his family, wonder why Palmero hops around the world treating patients with illnesses that have long been controlled in the United States and other countries. But those who have seen him at work know what drives him.

Palmero has the "administrative skills, honesty and integrity, willingness to sacrifice and a clear vision of what needs to be done to alleviate human suffering," says Victor Valenzuela, MD, chief of clinics in Ishiaka Adventist Hospital in Bushenyi, Uganda.

Ron Boucher, a division director for Gospel Outreach, an evangelistic ministry to Seventh-day Adventists, spent a day in Gambia with Palmero and witnessed the trust he cultivated with local residents.

Boucher had American dollars and needed to exchange the money for Gambian currency. Boucher was amazed when he witnessed Palmero's gift for negotiating.

"Dr. Palmero's friend gave us a large sack full of Gambian money, trusting us to return with the change and the U.S. dollar equivalent for the amount we spent." When the two men returned, the businessman invited them to his home for lunch.

Going abroad

Though Palmero enjoys the adventure, his career could have been a bit more mundane. After medical school, he had planned to take a general surgery residency. But his father had a stroke and his younger sisters and brothers were in school. The family needed help with finances so Palmero applied for work abroad.

In 1996, he was supposed to be a corporate medical advisor for Eagon, an integrated wood product manufacturer based in Korea, but was told to go to the Solomon Islands to be chief of the new Seoung Min Memorial Hospital near the company's logging and forest replantation camps.

The reassignment proved pivotal to his career. Palmero welcomed the rare management opportunities afforded to someone with his background. At the age of 28, he was a hospital administrator, a medical director at 32 and a country director at 34.

The hospital served the island province of Choiseul, home to about 30,000 people. While there, Palmero honed his administrative skills. It was imperative that he manage the hospital according to the charter of its foundation, but he also learned to be kind and relate with the villagers when their health centers struggled to deliver basic health care.

Palmero was mesmerized by the nature around him. There were crocodiles on the edge of rivers, dolphins that followed his boat and remote coastal villages that beat drums when he arrived.

He participated in festivals and wore flowers that irritated his neck. He dived with sharks and led them coconut meat, and he treated diseases he had never before seen in a medical textbook and wasn't at all sure how to approach.

"This experience fortified my psyche to brave alone and face challenges without expecting help from anybody," he says.

It was that experience in Choiseul that prepared him for the realities of Liberia--a place where patients offered him gold nuggets the size of film canisters to pay their hospital bills while others pulled diamonds out of their pockets in exchange for rice.

Liberia tested his resolve every day. As a leader, he had to stay calm when trouble arose. Or as Palmero puts it: "Leaders should be a fountain of different instincts and be innovative in concealing personal fears."

His next goal will require an equal amount of bravery.

He plans to solicit funding in the coming months for reproductive health, family planning, safe motherhood and the prevention of female genital mutilation and HIV. While all health conditions, except female genital mutilation, are challenges in the United States, they are compounded in a country with scant resources.

Those with HIV, for example, don't receive the treatment they need. They are lepers in their own homes and often die alone. Palmero wants to dedicate more time to this and other health issues.

"But I need funding for it," he says. "Most of my funding is for water and sanitation."

In two or three years, Palmero will return to what he calls mainstream medical practice. By then, both of his children will be old enough to attend school and will need a more stable environment.

The medical system in the United States with all of its medical malpractice and bureaucratic red tape won't be an option for him. Limited immigration opportunities will likely add Alberta, Canada, to a long list of countries he has called home. It will provide yet another chance to learn about medicine and how to reach out to people.

"My sense of the world view is wide," he says. "It gives me a lot of satisfaction of seeing what's really going on."

1 Palmero often sees patients in the schools. Here, he examines a teacher.

[ILLUSTRATION OMITTED]

2 Palmero conducts classes for women on reproductive health and child survival.

[ILLUSTRATION OMITTED]

3 Dr. Palmero (4th from left) and his staff in The Gambia.

[ILLUSTRATION OMITTED]

4 This small well will provide water for 100 families.

[ILLUSTRATION OMITTED]

Name: Ephraim C. Palmero

Age: 35, Married with two children, lives in Serrekunda, The Gambia

Current Positions:

* Adventist Development and Relief Agency International, Country Director, The Gambia

* West Africa Union Mission, Director, Health Ministry for Liberia, Sierra Leone and The Gambia

Education:

* Bachelor's Degree in Biology, Adventist University of the Philippines, 1988

* Doctor of Medicine; Angeles University Foundation, College of Medicine, Philippines, 1993

* Post-Graduate Medical Internship, Manila Adventist Medical Center, 1994

* Certificate, Business Management & Adm, Cambridge International College, U.K., 1997

* Certificate, Executive Management, College of Professional Management, U.K., 1998

* Post-Graduate Course, Occupational Health & Safety, College of Public Health, University of the Philippines, 2000

* Pursuing MBA, Hospital Administration, Washington International University, USA

Hobbies: Tennis, basketball, table tennis, swimming, snorkeling and hiking.

On his career: "I'm more than a doctor. I don't treat a patient; I treat a village."

Monique Fields is a journalist for the St. Petersburg Times in St. Petersburg, Fla.