On the July day President Obama introduced Dr. Regina M. Benjamin as his choice for Surgeon General, she stood at the podium and cast her eyes over the assembled crowd. Not one member of her immediate family was present to witness her ascent from small-town Alabama girl to the country's most visible advocate on public health. Benjamin's father died suffering from diabetes and hypertension. Lung cancer claimed her mother. Her brother died of an HIV-related illness.
"My family's not here with me today, at least not in person, because of preventable diseases," Benjamin said. "While I can't change my family's past, I can be a voice in the movement to improve our nation's healthcare and our nation's health for the future."
Those personal losses helped to fuel Benjamin's resolve to improve the access and delivery of healthcare for others, especially people living in impoverished communities like Bayou La Batre, Ala., where Benjamin, 53, spent most of her life before starting her job as the country's 18th Surgeon General in November. (She was officially sworn into office in January.) Not surprisingly, the healthcare delivery systems in places like Bayou La Batre and other less affluent communities frequently aren't supported by information technology of the type adopted by hospitals affiliated with research universities and major urban areas.Bayou La Batre, a small fishing village on the tip of the Alabama oast, was immortalized in the movie Forrest Gump. Of the town's approximately 2,500 residents, about 80 percent live below the poverty level and many do not have health insurance. A third of the town's population are immigrants from Vietnam, Cambodia and Laos. Yet for more than two decades most residents, including the mayor, have been Benjamin's patients.
They have paid her in dollars, bushels of oysters and simple gratitude. During much of her time working there, Benjamin was the sole physician in town and she often drove her pickup truck to patients' homes if they were elderly or too ill to visit Bayou La Batre Rural Health Clinic, the nonprofit organization she founded in 1990. "Healthcare with Dignity" reads the group's catchphrase on its low-tech Web site.
Bayou La Batre is far from Silicon Valley, yet despite Benjamin's tech-impoverished background she has a history of supporting health information technology. From 2000 to 2001, she led the University of South Alabama College of Medicine's telemedicine distance learning program, now known as the Office of Emerging Health Technologies, which helps doctors care for patients in rural and medically underserved areas through technology that uses telephone lines as a conduit. The program has since expanded with a mandate to explore and design novel solutions to meet the medical needs of the chronically ill in rural Alabama.
Benjamin's personal experience speaks to the precariousness of paper records and the advantages of digitization. After hurricanes flooded her clinic, Benjamin and her longtime nurse, Nell Bosarge Stoddard, spread out patients' files to dry in the sun in order to salvage their important health data. The records were ultimately destroyed in a fire. The Huffington Post, an online news Web site, reported that after those experiences Benjamin "pointed out the need for electronic records that were invulnerable" to natural disasters.
Ingrained perseverance
Benjamin's most impressive quality may be her perseverance. Early in her medical career, she traveled on weekends beyond Alabama's borders to work as an emergency room doctor. In 1991, she earned her Masters in business administration from Tulane University, in New Orleans, in order to run her organization more effectively and to optimize reimbursements from Medicare and Medicaid. When Hurricane Katrina decimated Bayou La Batre in 2005, Benjamin treated scores of patients for free, getting by with donations of supplies and promising pharmacies she would pay the bills for the prescriptions ordered.
She learned about sacrifice growing up in a household that didn't have much but valued giving to others. "My grandmother lived on U.S. Highway 98, and during the Depression she would leave sandwiches and lemonade outside for the hobos," Benjamin said in a biography posted on the Web site of the National Library of Medicine, in Bethesda, Md. "Those values she passed on to my mother and ultimately to my brother and me."
After graduating from Xavier University in New Orleans with a B.S. in chemistry, Benjamin was part of the second class at Morehouse School of Medicine in Atlanta, where Dr. David Satcher, the former Surgeon General, taught her community medicine. The National Health Service Corps paid for Benjamin's medical degree, which she finished at the University of Alabama at Birmingham, since Morehouse was then a two-year program. The scholarship terms mandated that she spend several years working as a doctor in a community that lacked medical professionals. Benjamin landed in Bayou La Batre, not far from where she grew up.
Benjamin could have found plenty of reasons to pack her bags. Her clinic has been destroyed three times, twice by hurricanes" Georges in 1998 and Katrina in 2005, and once by fire in 2006. Each time she fought back feelings of despair and worked alongside the community, as well as volunteers from around the country, to rebuild it, often putting up her own money to cover costs.
"Through floods and fire and severe want," said President Obama when he introduced Benjamin as his nominee for Surgeon General, "Regina Benjamin has refused to give up."
MacArthur awardee
The path Benjamin chose to travel has won her many accolades, including a MacArthur "genius" award in 2008 that came with a grant of $500,000 spread over five years. The money can be used in any way the recipient chooses. In a previous interview Benjamin was said to be mulling whether to spend the money to endow her clinic or set up math and science scholarships for students.
Although most of her professional life has been spent working as a country doctor, Benjamin also participated in shaping medicine's bigger picture. In 1995 she became the first physician under 40 and the first African-American woman to be elected to the American Medical Association Board of Trustees. In 2002 she became president of the Medical Association State of Alabama, making her the first African-American female president of a state medical association in the United States.
Benjamin said she got involved in the state and national groups to help her patients with issues that went "beyond the prescription pad," such as funding for Medicare and Medicaid.
As Surgeon General, she oversees the operational command of 6,500 public health officers who serve around the world to protect and advance the health of Americans. She has already called for an effort to encourage more minorities to become doctors and is part of the administration's antichildhood obesity effort.
While Benjamin now works hundreds of miles from her former neighbors on the Alabama coast, her priorities of helping the poor and the uninsured to find healthcare are the same. "I want to be sure that no one"no one"falls through the cracks as we improve our health care system," Benjamin told the crowd at her nomination. Landing the job, she added, "is a physician's dream."
