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Alum finds fascination in disease and the end of life

Yale Medicine Magazine, 2009 - Spring


Robert Buckingham’s career has taken him around the world as he studies HIV/AIDS, prostitution and hospice care.

Robert Buckingham, Ph.D. ’78, saw a lot of people die when he served in the U.S. Navy during the height of the Vietnam War. But he was more drawn to illness-related mortality, even in combat zones. “In my travels throughout Southeast Asia during the war, I saw a lot of disease and death,” he said. “I got fascinated with diseases.”

Buckingham’s career has run on the tracks of disease and death ever since. Usually the tracks are parallel, but they have also diverged and intersected, frequently taking him back to the places in Southeast Asia where his interest was first sparked.

For Buckingham, an epidemiologist and professor of health science at New Mexico State University’s College of Health and Social Services, the intersection became personal as he entered the School of Public Health in the 1970s. His mother had just died of breast cancer, “so I was interested in the care she got—and the lack of care.” His frustration over the hospital’s aggressive attempts to keep her alive instead of alleviating her suffering led him to become involved in palliative treatment.

At the same time, the late Florence S. Wald, R.N. the former dean of the School of Nursing, was trying to establish the first inpatient hospice in the United States. Under Wald’s tutelage, Buckingham helped to write a grant proposal that led to funding for hospice care. In researching his doctoral dissertation, he came to the conclusion that care for the dying was better in a hospice than in a hospital.

The Connecticut Hospice opened in Branford in 1974. Today there are about 8,000 hospices around the world (including more than 4,500 in the United States), according to Stephen Connor, Ph.D., vice president of research and international relations at the National Hospice Foundation. Buckingham had a hand in developing about 90 of them. “Bob is remarkably intelligent and capable,” Connor said. “He certainly is someone well-regarded in the field.”

Buckingham moved on to other areas of public health, notably HIV/AIDS prevention among sex workers. He returned to Thailand as the AIDS epidemic spread and has since studied condom use among prostitutes in that country’s commercial sex industry and started a pediatric hospice for children with AIDS there. He spent the 2000-2001 academic year “developing programs for commercial sex workers as well as treatment programs for workers who were HIV-positive.” Before his research began, only 11 percent of sex workers’ clients had used condoms. His study, published in the journal AIDS Care in 2005, found that the rate had risen to 51 percent. It wasn’t ideal, but in some brothels as many as 89 percent of the workers’ clients use condoms, and overall the HIV rate in Thailand has “decreased significantly,” he said. Buckingham concluded that more focus needs to be put on native Thai patrons, who are less likely to use condoms than Western or other Asian customers.

Buckingham is trying to transfer that model of HIV prevention to prostitution in Latin America. One such place is Ciudad Juárez, Mexico, just across the border from El Paso, Texas, and not far from his campus in Las Cruces, N.M. “When you see poverty you see prostitution, and when you see prostitution you see disease,” he said. He has encountered little opposition from the authorities, even though Mexico is a heavily Roman Catholic country. “We usually don’t get interference,” he said. “We’re trying to help.”

Most recently, Buckingham has been asked by the government of Honduras to form the country’s first health commission. The need for health care is acute, especially for people living on the islands off the coast where care is “nonexistent,” he said. “What we’re doing is a simple needs assessment affecting the country.” He plans to get the project in full swing while on sabbatical in 2009-2010.

Honduras also has a disproportionately high share of Central America’s HIV/AIDS cases—some estimates have it as high as 60 or 70 percent—so Buckingham will work to promote condom use there. He will also likely be working with the dying, because he helped to establish a hospice in that country.

His work with hospices and sex workers isn’t all that divergent, he said—in fact, the two tracks crossed one day in Thailand. He was interviewing prostitutes when a woman, wrongly assuming that he was a physician, begged him to care for her sick infant. “I said, ‘I can’t take care of your baby,’ and gave it back to her. She said, “No, no!’ and just ran away. We brought it to the medical school. Sure enough, the baby was HIV-positive. Word went out that I found a place for these dying kids.”

Buckingham helped set up a hospice there, too. “Life is weird sometimes,” he said.

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