The Public Health Experiences of Dr. C. Everett Koop

by
Noel E. Kroncke, President

The Children's Hospital of Philadelphia

- It has been claimed that C. Everett Koop is not qualified to.
be Surgeon General because of his lack of Public Health experience.
Obviously, those making such judgments are unfamiliar with his long
and productive work in the Public Health area. Dr. Koop has
stated that it was the delivering of babies in their homes in
Harlem more than forty years ago that prompted his first interest
and subsequent activities in Public Health. They continued through-
out the early years of pediatric surgical practice at the old

Children's Hospital of Philadelphia and they remain to this day.

From 1960 to 1980, Dr. Koop was vice president for four terms
and a board member of MAP International, a relief agency located in
‘Wheaton, Illinois. MAP International started as the Medical
Assistance Programs providing medicines and material for doctors
working in Third World countries but as MAP's understanding of needs
increased and as sanitation, water supply, sewage disposal, famine
control, etc., became part of its services, the name was changed
to MAP International. « This organization has a relationship with

American and national physicians in eighty-three countries.
The wholesale value of goods. shipped by MAP International overseas

is now in excess of $200,000,000. Eight years ago, representing

MAP International, Dr. Koop procured from DeWitt Wallace of the -
Readers’ Digest $1.2 million in the form of a ten year irrovocable

- trust to fund 75% of the transportation of third-year medical
students in the United States and Canada to visit bush-type hospitals
in Third World countries for a minimum period of ten weeks.

Dr. Koop has chaired the MAP Readers' Digest International Fellowship
Committee for all of these years and has been instrumental in sending
about 750 medical students abroad for this experience. The reward
of this effort is now beginning to be seen because those early medical
students have completed their schooling, have taken their internships
and have gone on to specialty training including additional time in
schools of Public Health. They are now returning to Third World

countries for careers in international medicine.

Dr. Koop's activities in the Public Health sector are numerous.
In 1960 he made trips to Egypt, Ethiopia, Kenya, Uganda, Tanzania,
Belgian Congo (Zaire), South Africa, Nigeria and Ghana for the
purpose of acquainting medical missionaries of American and other
origins of the availability of the service of MAP International.
Much of this trip was undertaken by flying from bush hospital to
bush hospital in a Piper Cub to assess the needs of people in what

is now called the Third World.
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While on this trip, Dr. Koop represented the State Department
of the United States and was successful in convincing the Ministry
of Health of Ghana to build an American medical school in Accra
while it was receiving bids from three countries behind the Iron
Curtain. On his return, Dr. Koop negotiated the procurement of
faculty for that medical school. He sought and secured agreement
from the College of Physicians of Philadelphia, the non-profit
corporation that accepted the obligation to oversee our government's.
commitment to Ghana, The project was completed when each department
and division of the medical school had been turned over to a Ghanan

national director.

Dr. Koop's report on his African experience stimulated a
request from the United States and Canada to survey several hospitals
in Japan that were being supported largely by American money.

Dr. Koop then negotiated with the Refugee and Migration Service of
the United States State Department for the building of the Evangel
Hospital in Hong Kong and on his return raised additional money
privately for equipping the operating rooms of that institution. .
Students from the MAP International Readers' Digest International
Fellowships have periodically been sent there and Dr. Koop has

returned to that institution six times since it was built.
In 1964, at the request of the Ministry of Health of the
Dominican Republic, Dr. Koop set up nine hydration stations for
treatment during an epidemic of dysentery where the mortality was
‘in excess. of 70 percent. Then with the aid of the Dominican
Ministry of Health, Dr. Koop mobilized a group of local physicians
to carry out the intravenous medication and procured intravenous.
fluids flown in by the United States Navy from Panama. After the
epidemic had been controlled, the physicians who participated
continued to work in a non-profit capacity as part-time physicians

providing acute care, nutritional consultation, and other services.

In 1965, Dr. Koop visited European and Asian Fellows who had
been previously trained by him at The Children's Hospital of
Philadelphia. He lectured in medical schools and operated on
patients by teaching hospitals in Greece, Iran, Thailand, the

Philippines, Taiwan, Japan and Hong Kong.

In 1972, there was the beginning of a bilateral relationship
between The Children's Hospital of Philadelphia and the Children's
Hospital in Krakow, Poland, an institution which is a gift of the
American people to the people of Poland. Dr. Koop trained the

_Surgeon-in-Chief first and his assistant and arranged for the
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training of their chief of Anesthesiology at Philadelphia's Children's
Hospital. This work has gone on so that at the present time staff

of the Children's Hospital provide the respiratory therapy and inten-
sive care for the extensive open heart surgical program at that

institution in Poland.

In 1976, Dr. Koop met with the Minister of Health of Poland as
well as the President of that country to urge the use of funds
' provided to Poland by the United States for the conquering of
surgical disease as well as medical ‘problems. already being cared for.

For more than ten years, Dr. Koop was the only American on the -
Council of the British Association of Paediatric Surgeons , which
provided the basis for annual international congresses of pediatric
surgeons from all over the world. As a result he has been Visiting
_ Professor or Lecturer (sometimes on an annual basis for three or
four years in succession) in Liverpool, Stockholm, Bremen, Amsterdam,
Rotterdam, Katmandu, Jerusalem, Oslo, Copenhagen, Johannesburg, |
Barcelona, Madrid, Rome, Zurich, Geneva, Lausanne, Marseille, Abadan, .
Toronto and Mexico City. His teaching has enabled physicians in

these countries to provide better health care to their people.

One of the most beneficial aspects of Dr. Koop's involvement

with other countries has been the visits by surgeons from these
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countries to The Children's Hospital of Philadelphia for retraining
in pediatric surgery. According to the new Administration, updating |
Of medical knowledge is the goal of many of the international programs
of the Department of Health and Human Services at this very time.

Preceding all of the above and continuing to the present time,
Dr, Koop has had an interest in the tribe of Tarascan Indians in
Southwest Mexico. He was stimulated to do this by the essential
lack of medical care except in those few parts of the tribal lands
where they were contiguous with Mexican towns in his early years
of association with them. He has encouraged other physicians to
go to the tribe periodically during their vacations and to provide
diagnosis and suggested treatment for this group of 70,000 people.
Dr. Koop arranged in that tribe many years ago a series of
small dispensaries with local staff trained by the American physician

volunteers.

His import on the American health care scene has been equally
dynamic. Beginning with Dr. Koop's association with the then
developing specialty of pediatric surgery (he was the sixth person
in America to devote his surgical skills to children alone) he
had the opportunity to assess the underlying causes for the

unbelievably high mortality of children undergoing surgical procedures.
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His pioneering in and support of others in developing pediatric
anesthesiology has helped make anesthesia safe for children. The
mortality of newborn surgical procedures for many congenital defects
has been turned around;. survival rates that were under 10 percent

are now over 90 percent, a complete reversal.

When Dr. Koop began his surgical odyssey, many pediatricians
| scoffed at the idea that cancer was a Public Health problem in
children. He kept hammering away at that concept, developing new
surgical techniques as he went, proving that better survival was

possible.

Dr. Koop's work has been the essence of Public Health.