Women and Children First

OB-GYN dedicates career to providing care to underserved population

John Heusinkveld, M.D., thought when he was a medical student that he didn’t want to practice obstetrics and gynecology (OB-GYN). So, during his third year, he chose the specialty as his first clinic rotation to get it out of the way.

But he was surprisingly pulled in that direction, and after graduating from VUSM in 1996 and completing two years of an internal medicine residency and a medical informatics fellowship, he did a second residency in OB-GYN in Tucson, Ariz.

One thing he has always been sure of is that he wanted to care for the underserved population.

For the past 10 years he has been a practicing OB-GYN in his home state of Arizona and neighboring New Mexico, tending to the needs of Native American women on a Navajo reservation in Tuba City and volunteering twice yearly in Afghanistan. He said he can’t imagine doing anything more fulfilling.

Called to Serve
Born in Rochester, N.Y., and raised in Tucson, Heusinkveld’s father was a physician, so, aware of the demands of the profession, the younger Heusinkveld looked at other careers before he chose medicine.

“I kind of tried everything else first,” said Heusinkveld, who has a master’s degree in computer science. “I finally decided nothing else was going to work for me.”

After completing his OB-GYN residency he went to work for the Indian Health Service and also joined the Public Health Service, which deployed him to help with the Katrina and the Gustav/ Hanna/Ike hurricanes.

“Those were interesting experiences,” he said. “It was eerie driving across the devastated areas and observing the destruction of civilization, basically. We stopped for gas at a gas station and the owner turned off the pumps right as we pulled in. They were about to run out. He turned on a pump so we could fill up and that nearly caused a riot. We got a view of how fragile civilization is,” he said.

He worked as a general OB-GYN on a reservation in Ship Rock, N.M., before moving to another reservation in Tuba City, Ariz., to start a center to deliver state-of-the-art gynecologic surgical care to the Native American population. He recently became board certified in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery.

“The Navajo people and Hopi people have maintained their traditional culture. With the older generation you have to be careful getting informed consent because in the Navajo culture you don’t talk about bad things that might happen. That’s like wishing they would. When you are talking about possible complications about a procedure, you have to be careful in how you phrase them,” he said.

From Arizona to Afghanistan
One of his partners on the reservation, Qudratullah Mojadidi, M.D., is an Afghan-American who left Afghanistan in the late ‘60s because his family was being persecuted by the communist government. He came to the United States where he trained in OB-GYN and established a practice. As soon as the Taliban fell, Mojadidi went back to start a program to train Afghan OB-GYNs in western standards. They now form the faculty of a teaching hospital there.

“Dr. Mojadidi suggested to me that some of my skills would be valuable over there. I thought about it for a year before I got up the courage to go and then I went in May 2011 and spent two weeks there with Cure International,” Heusinkveld said. “It is definitely not safe for foreigners over there. The organization does everything it can to minimize the risks. The guest house where I stay still has personal items in it from people who were killed over there. Ultimately, I decided I really wanted to do it.”
On his first trip to Afghanistan he flew to Dubai on Emirates airline and noticed that the news feed on the plane had been blocked out.

“My wife (Dominika A. Grodzicka-Trudgett, M.D., '00), texted me that Osama Bin Laden had been killed. I had no idea what the reaction in Afghanistan would be like. I decided having just spent 16 hours on a plane, there was no way I was going to turn back,” he said.

Heusinkveld volunteered at the Cure International teaching hospital in Kabul, training physicians in evidence-based medicine and providing care that is up to the standards of the developed world.

“I think it’s a good facility. I’ve been back four times since then, and I feel like it’s a very successful model,” he said. “The doctors over there are all pretty fluent in English. They study it at the University. Any time I need to communicate with a patient, they translate. I’ve been studying Farsi there. It’s not yet sufficient where I can directly interview a patient or explain an operation.”

The biggest challenge is equipment, all of which is donated. Heusinkveld purchased most of the laparoscopic equipment on eBay, which allowed him to help the local physicians perform the first laparoscopic hysterectomy ever in Afghanistan, where he later oversaw the first ever hysteroscopy.

Recently, a generous donation of equipment from the Karl Storz Corporation, which also supports his work on the Navajo Reservation, has allowed progress to accelerate.

Cultural Differences
All of the OB-GYNs he works with in Afghanistan are women. The men train as family medicine providers, although they are trained to deliver babies and perform C-sections. A woman can receive medical care from a male physician only if there is no female physician available.

“During Taliban time there was very little medical care for women because the attitude was that women shouldn’t be physicians because that involved educating them. It was unacceptable for a woman to receive care from a male physician,” Heusinkveld explained. “It’s still a very conservative Muslim culture, but the vast majority of Afghans would say ultimately
a woman’s health is more important than her modesty.”

About one in 11 Afghan women dies as a consequence of childbirth. In 2004, less than 20 percent of births were handled by a skilled attending physician. Today, nearly 40 percent of births have a midwife in attendance. That’s a significant improvement, Heusinkveld said.

Although he practices some general OB-GYN, much of his time is spent repairing complex urogynecologic issues that are prevalent in developing countries such as vesicovaginal fistulas and pelvic organ prolapse.

“My career has been enormously fulfilling. I like the mixture of medical and surgical care. I like the fact that unlike other surgical specialties we tend to follow our patients over a long period of time. I like taking care of women. The problems of women and children in the developing world are so compelling that this, to me, is the most fulfilling field I could be in.”

A group of graduates from the teaching hospital have started their own hospital called Al-Hayat, located outside of Kabul, where they are implementing the same model of ethical, evidence-based care. Witnessing their dedication to improving care for women and their children gives Heusinkveld hope for a part of the world torn apart by violence.

“This is totally an Afghan effort. They have built this from the ground up. I contributed a small amount of equipment and expertise. I work with incredibly talented people over there—a lot of whom are from disadvantaged backgrounds who found ways to educate themselves,” he said. “It gives me a huge amount of hope for the future, and as a result of my experience over there I think I have a totally different view on the future of Afghanistan than most people over here. If I had one message to American readers it would be: don’t give up on Afghanistan and have patience.”