Back to school with Colombia’s top doctor

Although he believes that Colombia already has too many medical schools, José Félix Patiño, M.D. ’52, HS ’58, is leading a drive to create one more. He hopes the new school—a joint venture of the prestigious Universidad de Los Andes and the Fundación Santa Fe de Bogotá (FSFB), a medical center Patiño and others founded 20 years ago thanks to the philanthropic gift and dedication of Alfonso Esguerra, M.D. ’64, and his wife, Gloria—will raise the level of medical education in Colombia. Patiño’s model for the new school is the Yale System of medical education.

“The main thing that we are taking from the Yale System is the flexibility of the curriculum and the responsibility the student has in learning, and not only what the teacher provides the student. The students have to learn how to learn and be students for the rest of their lives,” Patiño said in January during a telephone interview from his home in Bogotá, Colombia’s capital. “When I was a medical student at Yale, my fourth year was practically ad-libbed. I could do whatever I wanted because I had completed all my subjects, and that gave me the opportunity to attend lectures and classes in other subjects all over the university.”

This new medical school, scheduled to open next year, will be the latest in a string of achievements in medicine, education and social welfare that Patiño has brought to his nation during a 45-year career. Since returning home after his education and training in surgery at Yale, Patiño has served Colombia as director of the Association of Medical Colleges, minister of health, rector of the National University and president of the National Academy of Medicine. He worked with John D. Rockefeller III and Robert S. McNamara to bring Rockefeller Foundation and World Bank grants to Colombia. In recent years he also found time to write a biography of the opera diva Maria Callas.

As minister of health in the mid-1960s, Patiño introduced generic drugs to Colombia, dramatically lowering the cost of medications. While rector of the National University, one of the country’s largest public colleges, Patiño restructured 34 distinct faculties, brought in full-time faculty and obtained funding for teachers and researchers.

Patiño has continued to indulge his passion for opera, acquired from his father, also a physician, who took his family to listen to operas at Bogotá’s Teatro Colón. While at Yale, Patiño often traveled to New York to hear a new singer with a marvelous voice who, although well-known in Europe and Latin America, had yet to make her debut in the United States. That singer was Maria Callas. “I became interested in her life, always in search of perfection,” says Patiño. “I own every opera she recorded but three. She sang operas that had been in obscurity and brought them to light.” Two years ago Patiño’s biography of Callas, now in its second edition, was published by Editorial Kimpres of Bogotá. He is the author of 18 monographs, over 300 papers and eight books, including a major surgery textbook dedicated to his professor at Yale, the late Gustaf E. Lindskog, M.D. This fall he will deliver the Distinguished Lecture of the International Society of Surgery (of which he was president) at the annual Clinical Congress of the American College of Surgeons in Chicago.

Looking back on the heady days of the 1960s, when he hobnobbed with McNamara and Rockefeller and served on a delegation that welcomed President John F. Kennedy on a state visit to Colombia, Patiño laments a change in international lending practices. “At that time the World Bank had a different philosophy than it has today. Their philosophy was that of John F. Kennedy, to help the poor,” he says. “To see how the World Bank functions today, pushing globalization without considering the local situation, is traumatic.”

The Fundación’s vision of helping the poor has become reality in six low-income neighborhoods bordering its teaching hospital. The 180-bed hospital and medical center was the first in Latin America to have its own full-time staff of physicians. (Typically, Patiño says, hospitals in Latin America rely on the services of physicians who work part time while maintaining private practices.) Its mission includes the education and training of physicians, as well as providing medical care. Proceeds from the center’s clinical fees subsidize services for the poor that go beyond health and medicine. “The community health program is not only a health program,” Patiño says. “It not only relates to outpatient centers, but also to community development in terms of the environment and starting people on their own small industries. It has been a tremendously effective community program.”

Several members of the Yale medical faculty have traveled to Colombia to see the foundation and its programs firsthand. Among them are former Dean Gerard N. Burrow, M.D. ’58, HS ’66; former Deputy Dean Robert H. Gifford, M.D., HS ’67; Yale-New Haven Hospital President Joseph A. Zaccagnino, M.P.H. ’70; and former Chief of Staff John E. Fenn, M.D. ’61, HS ’66 (to whom Patiño refers as his brother).

The center also brought medical students from the United States to Colombia for training periods of two months to a year. During the 1990s, several came from Yale to a hospital in a small town outside Bogotá. Concerns over security put an end to that program, however.

Patiño’s desire to attack poverty comes from a long-held belief that it lies at the root of Colombia’s troubles. Two left-wing guerrilla groups who claim to speak for the downtrodden are at war with both the government and right-wing paramilitary groups. Both the paramilitaries and the guerrillas fund their activities through alliances with drug traffickers.

“The political system here is really complicated,” says Patiño. “The principal reason is the poverty, the extreme difference between the people of the higher socioeconomic class and the people in the lower level. There is a tremendous disparity and it is increasing instead of decreasing.”

Despite the prevailing image of Colombia as a country torn by warfare and strife, with large swaths of land under the control of guerrillas or paramilitaries, Patiño says Bogotá is a safe place. “If you come to Bogotá today you will find a normal city; entertainment, movies, restaurants,” he says. Also, he adds, Colombia is a marvelous country that has produced figures of the stature of Nobel laureate Gabriel García Márquez, painter Fernando Botero, rock artist Shakira and Formula One racer Juan Pablo Montoya.

He is optimistic that the country’s recently elected president, Alvaro Uribe, who campaigned on a slogan of a “firm hand” with insurgents, can improve the political situation. In the meantime, life goes on and he continues with his plans for the new medical school.

The new school, Patiño says, should be up and running by January 2004. Why would someone who believes there are too many medical schools want to add one more? In the 1970s, there were only eight in this country of 41 million people. Now there are 45, most of which were established in the past decade since the national government began to promote higher education by encouraging the opening of new universities. “Many of them are really of very poor quality,” Patiño says of these schools. “The great contribution we think we will make is to set higher standards in medical education and serve as a model for other medical schools in Colombia and Latin America.”