by Claire Panosian Dunavan, MD
Top The author in a lecture hall of the London School of Hygiene and Tropical Medicine, 1979. Second: Student laboratory at the London School of Hygiene and Tropical Medicine, 1979. Third: Waiting room at L’Hôpital le Bon Samaritain, Limbé, Haiti, 1972. Bottom: Dr. Claire Panosian Dunavan is a past-president of the American Society of Tropical Medicine and Hygiene and a longtime UCLA faculty member. Photos: Courtesy of Dr. Claire Panosian Dunavan
GUADALCANAL, NOVEMBER 1942. Another night of war in the Pacific. Above-ground, the air buzzed with insects and enemy ordinance. In foxholes, weary Americans in boots, fatigues and steel helmets shifted restlessly and counted the hours until dawn.
For a soldier on Guadalcanal, a hole in the ground was the safest place to spend the night. But that safety came with a price: disease-bearing mosquitoes. One need only visit the hospital field tent for proof. There, by the light of flickering electric lanterns, medics tended patients whose blood swarmed with the delicate rings, crescents and clusters of malaria.
Nearly half-a-million U.S. servicemen contracted malaria during World War II. My dad was one of them. A UCLA graduate and newly minted officer, he probably got infected soon after arriving in the Solomon Islands. Nonetheless, he remained on Guadalcanal for nine months, periodically suffering — despite multiple doses of quinine — the recurrent fevers, racking chills and drenching sweats of malaria. Finally, a superior officer said “enough.” With no time to say goodbye to his company, or even to collect his gear, my father was given the last seat on a plane leaving Henderson Field. Roughly a year later, after hospitalizations in the New Hebrides; Auckland, New Zealand; and Oakland, California, he married my mother and began a new military job in Los Angeles.
I share this story to answer the question: How did I find my way to tropical medicine? Looking back, my father’s wartime illness clearly played a role. Like my dad, my mother (who graduated from UC Berkeley, then worked at the 4th Bomber Command in San Francisco) also lost friends and classmates in the Pacific theater. As a young girl growing up in the 1950s, I was keenly aware of the hazards that my father and other World War II combatants had faced, especially when I gazed at an amber bottle on my father’s bathroom shelf. By the time I actually could read its faded label, its contents should have been tossed, but instead, there were some remaining pills of quinine to remind me of a microscopic foe that almost felled my father and, indirectly, me. Even then, I knew that malaria had cast a long, dark shadow on history. In the 20th century alone, I later would learn, it killed between 150 million and 300 million people worldwide, accounting for 2-to-5 percent of all deaths.
When I got older, my dad mentioned that he also had contracted dengue fever on Guadalcanal and had met native Melanesians with advanced cases of lymphatic filariasis and that both diseases were transmitted by mosquitoes. Mulling this information, my fascination with tropical medicine grew, along with a desire to better understand exotic blights. Travel also was in my sights. Luckily, the second goal aligned with that of my adventurous parents. By the time I started high school, our family had already visited much of the United States and driven through Europe on two trips, each lasting several months.
Then came the summer of 1972, a brief window of freedom between college and medical school, when my brother and I worked as volunteers at the only hospital serving a rural department in the far north of Haiti. Of course, I had no idea what to expect until our camion (a creaky, colorfully painted bus stuffed with people, goats and chickens) lurched to a stop at L’Hôpital le Bon Samaritain, a simple compound on the outskirts of Limbé, a town that lacked both telephones and electricity. Once inside, we found the hospital’s senior physician administering a shot of Demerol and sloshing disinfectant on an ugly, bloody wound before crudely reducing the jagged ends of a fractured tibia. Its owner had fallen from a mango tree, rolled in the dust and been carried for miles before receiving care.
That summer provided many things of value to a future tropical medicine doc, including an exposure to extreme poverty, epic humidity and giant cockroaches. But it also was fun. With my so-so high school French, I was able to speak with many local residents and hospital employees, surprising even myself with my ability to connect with people whose life experiences were vastly different from mine. On the other hand, the hospital’s Ground Zero — its waiting room — always snapped me back to the reason I was there. Almost every morning, its wooden benches and cement floor quickly filled with children and adults suffering every kind of misery, from malnutrition, measles and diarrhea to end-stage tuberculosis and malaria.
A few months later, as a medical student in Chicago, my life was far removed from Haiti, but my mentors at Northwestern encouraged my interest in tropical medicine. During my residency training, they even said yes to my plan to leave for a year to attend the London School of Hygiene and Tropical Medicine. In London, my hunger for a far deeper dive into parasitology, medical entomology and tropical public health finally was satisfied.
Amazingly, 40 years have passed, but tropical medicine continues to teach me about people, politics, economics and the environment, as well as about health and disease. Just one of the highlights along the way? In the mid-2000s, I spent two years working in Los Angeles, Washington, DC and Africa helping to conceptualize and author a report for the Institute of Medicine. In it, an international committee of experts chaired by a Nobel laureate economist recommended major global subsidies for insecticide-treated bednets and modern, lifesaving treatments for the many tropical poor still threatened by malaria.