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By Linda Bren
Each workday, about 10,000 employees of the Food and Drug Administration--scientists, engineers, physicians, investigators, educators, administrators, attorneys, and others--help make a difference in the health and well-being of Americans.
When their workday ends, many FDA employees volunteer at jobs that promote public health in their local communities, other parts of the United States, or around the world. "The people at the FDA are committed and dedicated to serving the public," says Janet Woodcock, M.D., deputy FDA commissioner for operations. "They are passionate about making a difference, even beyond their work at the FDA."
Woodcock says the agency encourages volunteerism. "Our people enrich others' lives and they are also enriched personally and professionally through volunteer work. In addition to providing a valuable service to a community, many of them bring back knowledge and new experiences that help them in their jobs at the agency."
FDA employees dedicate their time to a variety of public health services ranging from promoting AIDS awareness in an urban California community to treating malaria in the poorest country in the Western Hemisphere.
Here are some of their stories ...
For two weeks each summer, Susan Runner, D.D.S., chief of the FDA's Dental Devices Branch, leaves behind her air-conditioned office in Maryland to do dental work in 90-degree heat in El Salvador. Each year since 2003, Runner has taken a dental delegation of several people to help her, along with 10 suitcases full of donated dental care materials.
"The first year, I found two volunteers who agreed to be my dental assistants: a retired lawyer and a retired special ed teacher, both fluent in Spanish. Some years, I've had teen-agers who were fluent in Spanish acting as my assistants.
"We usually stay in a village called Aguaje Escondido. I set up my clinic in a little building called the dispensary. Villagers come there to see the promotoras, health workers who have been educated in basic health and first aid. There is no access to regular medical care or dental care.
"We eat with the families and live with the families. They're incredible people to be able to open their homes to us. They don't have very much, but they share with us what they do have.
"Often the homes have dirt floors and are made from cinder block or clay. It's like the inside is outside. There's no glass on the windows, and the roof doesn't meet the ceiling. Some are only two-room homes. It's not private. Oftentimes, bathing is a communal activity in the pila, a big wash basin outside where you wash clothes, dishes, and yourself. You wear a bathing suit, and dip water and throw it over your head.
"We work from about 7:30 in the morning till about 5:00 at night, seeing about 25 patients a day. Most of the villagers have never seen a dentist before. We do a lot of extractions of badly decayed teeth, but we also do many restorations. The people have a very high carbohydrate-based diet, a lot of sugar, a lot of sucking on sugar cane, so there's a high rate of tooth decay.
"You could probably spend a whole week restoring some of the mouths that we see. We want to see as many patients as we can, so we have to treat just the most troublesome or painful conditions. The people are incredibly grateful for anything that we do, or that somebody would care enough about them to be there at all. We give them toothbrushes and toothpaste and basic oral hygiene instructions. They love having a brand new toothbrush.
"The kids are really quite brave. All the work is done under local anesthesia, so they're totally awake. When you have an extraction, it's not sharp pain but it's a lot of pressure, which can be scary for many children and adults. It's sometimes even scary for my assistants because they are not formally trained dental assistants. They have a hard time with the blood at first, but they get used to it. By the time our two weeks are up, I have all my assistants doing cleanings and giving oral hygiene instructions themselves.
"There was one young woman who was one of the most beautiful women I've ever seen. But when she opened her mouth, I saw that her entire upper set of teeth were riddled with decay--just the most horrible thing. I was able to restore all of her six front teeth with tooth-colored resin material. When we finished and she looked at herself in the mirror, she said, 'I had never thought I would ever have a beautiful smile again. Thank you so much for providing this.'
"The people are desperately poor, but have joy in their lives, which they share with us. They also have plans for their future, which is why they are so happy that we can help provide oral health care.
"People ask me, 'Is it a vacation?' It's not a vacation. It's very hard living there. The running water and electricity don't work consistently. It's very hot and humid. I don't have a dental chair, X-rays, or good lighting. If I'm working on somebody's upper teeth, their head has to be in my lap because I'm sitting on a card table chair and my assistants have a flashlight to shine in their mouth and a little syringe to irrigate with.
"But you're basically doing what you love to do, you get appreciation for it, and you feel like you're helping other humans on earth. We're all part of humanity. There's very little you can do to change the whole world, but on a one-on-one basis, you can develop relationships that I think make things a little better for humanity."
Ilan Irony, M.D., is an endocrinologist in the FDA's Division of Metabolism and Endocrinology Products. His main focus is diabetes, which affects nearly 21 million Americans and is the sixth leading cause of death in the United States. Since 1999, Irony has contributed his time educating people who have been newly diagnosed with diabetes. He teaches part of a two-day class on diabetes management offered throughout the year at Suburban Hospital in Bethesda, Md.
"I teach the first portion of the course, an introduction to diabetes. I talk about the physiology involved, normal and abnormal insulin metabolism and glucose metabolism, types of diabetes, treatments, and complications. You can talk for years on diabetes, but even though it's just a two-day course, it's a good overview for patients to help them understand how to care for themselves. It covers many topics and includes a lecture and hands-on cooking demonstration from a dietitian, foot care information from a podiatrist, blood glucose monitoring, and more.
"Each class has about 30 patients. Often, their families come with them. We are starting to see more teen-agers--about one-fifth of the patients are teen-agers.
"There are lots of questions. People want to know, 'Do I have the right diagnosis? Do I really have diabetes? Do I have the right medication?' At the point that they come to the class, the diagnosis is still relatively fresh and it's hard for them to accept and comprehend. They don't usually have a very good idea of what diabetes is, or that they can still lead a normal life and have a normal life span if they comply with the treatment and the associated lifestyle changes.
"I try to reassure them. I tell them that coming to the class is a step in the right direction, but everything that they hear is not going to be valid five or 10 years from now. They'll want to keep themselves updated and educated on the progress of diabetes research because the knowledge is evolving and we'll probably have more efficient treatments and safer treatments in the coming years.
"The class benefits both the patients and the presenters. Because I work in the field, I have a general feel of what's on the horizon in terms of treatments for diabetes. I can't discuss specific products in development, but I can give them a broad view of where the science is going. There is a lot of hope for new treatments and diagnostic and monitoring methods.
"The class gives me a real appreciation for what patients go through--the psychological aspects as they accept their diabetes as a disease. I can take that back to my work at the FDA as a drug reviewer and put those thoughts into protocols for testing and development of products.
"The other doctors in practice who teach parts of the course also benefit. It gives them an opportunity to listen to patients to find out exactly what their concerns are. As doctors, we tend to think about measures of glycosylated hemoglobin and other parameters for diabetes that affect the outlook for health. But patients' concerns are more about: 'How is it going to limit my life? What type of diet will I be on? How can I fit an exercise program into my daily activities with my already stressful life?' It gives a different perspective to both the patients and the doctors.
"For anyone who wants to gain a better understanding and control of their diabetes, I would suggest that they look for classes offered by their local hospital or the American Diabetes Association. The cost may be covered by insurance."
As a biologist in the FDA's Center for Veterinary Medicine (CVM), Michele McGuinness, Ph.D., spends much of her workweek evaluating new production drugs for poultry. But the weekends are spent with her horses, training to track down missing people.
McGuinness serves as assistant commander and team training officer for TROTSAR, a volunteer equine search and rescue (SAR) team that works with the Maryland State Police. McGuinness credits her 21-year-old equine partner, Tom, with saving a person's life. And she credits FDA-approved animal drugs with keeping her partner healthy enough to perform the rescue.
"We ride and train year-round, in all kinds of weather. We have to learn incident management standards, in addition to search and rescue skills, as part of the Department of Homeland Security mandate for search teams. We are trained in wilderness first aid and search techniques like clue awareness, crime scene preservation, and map and compass reading. If you're not properly skilled and trained, you become a liability on a search and rescue mission.
"You're supposed to be in good physical condition and so is your horse. If the lost person cannot be evacuated using your SAR horse and you can't get a vehicle in or land a helicopter, you may have to help carry somebody out on a stretcher. They say in Maryland, you're never more than five miles from a road. But five miles is a long way to carry somebody!
"Our team is called out between three and six times a year. We're supposed to be ready to deploy within an hour at any time of the day or night with our horses. We've already had three SAR missions this year. On the most recent one, a missing plane search, we worked with the Maryland State Police, Civil Air Patrol, and ground teams. The plane and deceased pilot were located by a ground team. Our TROTSAR mounted teams were working up the mountain toward the suspected crash site when we heard the find over the radio. We were happy to be part of a successful mission, although sad for the pilot's family.
"Horses provide us with a tremendous field of vision. If you're on the ground, you can't see anywhere near what we can see from the top of a horse. We can cover large distances without tiring because the horse is doing the walking. Having the horse doing the walking frees us up to look for clues or look for people. We don't have to watch where our feet are going--the horse is doing that. And they can carry a lot more gear than people can on their backs.
"When I met Tom, he was wild, sometimes dangerously ill-behaved, and nobody was willing to ride him. I heard Tom called 'useless,' but he was all I had to ride. It was an adventure, Tom and I working things out, but we did.
"Tom and I were out riding with my friend and his inexperienced horse when the accident happened. At one point, one of the reins got caught around the horse's right hind leg. He suddenly exploded into a fury of panicked bucking. I've never heard anything hit the ground so hard as my friend's body smashing onto that trail.
"My friend wasn't breathing. He looked pretty much dead, all crumpled up and with a bloodless white face. But there was a pulse, and I was able to restart the breathing. Eventually my friend regained consciousness, and I couldn't find any broken bones. We were several miles from a house or a road, and his horse was long gone. I had no cell phone service. My friend was lapsing in and out of consciousness and stopped breathing again. I had no choice but to load him onto Tom and take him with me.
"It took us nearly an hour to walk out of the forest. I then had cell phone service and called 911. Tom was fabulous, remained calm even when the LifeFlight helicopter landed in the field nearby.
"Tom is handicapped. He has arthritis and a heart murmur and when he pushes too hard, I can feel his heart doing the 'hokeypokey.' A CVM veterinarian was able to give Tom some mitigating drugs that help him keep going. Those equine drugs restored my partner's ability to perform, and that ability saved a person's life. It is ironic that an old, 'useless,' disabled horse is my furry hero."
When Lila Kraai is not working as a consumer safety technician in the FDA's San Jose, Calif., office, she is often visiting with people who have HIV or AIDS, coordinating AIDS awareness events in the community, or packing donated food for delivery to people with AIDS and their families. She also served on San Jose's Disability Advisory Commission for three years. Once a week, after finishing her FDA workday, Kraai volunteers at The Neil A. Christie Living Center, an educational, social, and emotional support facility for people living with HIV or AIDS.
"I used to live in a house right down the block from a funeral parlor. A good friend of mine kept going to funerals for his friends with AIDS. I decided I wanted to find out more about the disease, so that's how I got into this work. I've been working to help people with HIV and AIDS for about 10 years now.
"At The Neil A. Christie Living Center, we visit with newly diagnosed people to educate them about resources available in the community. We organize classes in English and Spanish that deal with life issues facing those living with HIV or AIDS.
"We get doctors who work in the HIV field to come in and talk with our clients about the latest treatments. And we provide a meal once a week so people can meet each other, talk among themselves, and don't feel as isolated.
"Their biggest concern is that they don't think anybody wants to help them. They're afraid that people are going to shun them or not accept them. We want to reassure them that they are not alone and there are many others going through exactly the same thing. The center is a welcoming, safe place where nobody judges them, everyone is supportive, and names are not released to the outside. The atmosphere is comfortable and a coffee pot and Crock-Pot of soup are on all the time. We encourage the clients to share experiences and we help them figure out how they can carry on a productive life, and enjoy life.
"We have more men at the center than women. The men strike me as being pretty strong-willed people, with a positive attitude. They say the disease is not going to beat them--they're going to win. But sometimes they don't. It's sad when we lose somebody. We have a wake at the center when someone passes away.
"I feel a connection with anyone living with a disease or disability. I suffered a stroke when I was five years old that affected the left side of my body. I'm blind on the left side of both eyes so I cannot drive. On nice days, I bicycle to work, then bicycle to the center.
"Sometimes it's hard to go after work. I keep putting off chores that I need to do at home. But when I get there, I'm glad I went. The people are so nice and appreciative. It makes me feel good, whole, and fortunate."
Tan Nguyen, M.D., is a U.S. Public Health Service pathologist in the FDA's Office of Orphan Products Development in Rockville, Md. For each of the past eight years, Nguyen has spent a week's "vacation" with a team of 10 volunteers giving medical care to people in a rural area of Haiti. The Department of State describes Haiti as the least-developed country in the Western Hemisphere and one of the poorest in the world. Nguyen concurs and describes his firsthand experience.
"Our baggage allowance on the plane is 140 pounds per person, and everyone is carrying most of this weight in medications. We go to Leon, a village way up in the mountains. We set up a small, dilapidated clinic, and we stay in a little rectory up the street. The parish father supports us, and we sleep outside on the veranda under mosquito netting. I bring my own sleeping bag and pillow. They feed us mostly rice and beans. Sometimes they throw in a little meat and we try not to guess what it is.
"We walk to the clinic, start at 8 a.m., and work till dark when the last patient of the day is seen. We have some solar lights and running water now, but for years, we didn't have either. We just used a flashlight when we ran out of daylight and a water bucket for handwashing.
"We treat anything from malaria to machete wounds. We see about 1,000 people in five days. I usually see about 60 or more people per day, for a precious few minutes each. There are no lab tests, no X-rays, nothing but medications and stethoscopes. We make the best diagnosis possible by doing a physical exam and using our clinical skills.
"The people don't have transportation. Some of the villagers walk 15 miles over treacherous mountain trails to see us. By the time they get to us, it's night. They sleep outside the clinic, the next day we see them, and they spend another two days to go back up the mountains to their home. They spend five days to see us for five minutes! I don't complain anymore back home when I have to stand in line at the pharmacy for 15 minutes.
"I see children who are severely malnourished. I see kids eating dirt, they are so hungry. They are real skinny and have a big belly full of worms. I took my microscope with me one time. I wanted to see what parasitic diseases they have. I looked at about 30 stool samples from little kids in the village. Every one of them had multiple parasites. We treat all the children and adults in the village with antiparasitic medications so they don't get anemia. That's probably the biggest health impact we make. The teachers come to tell us they've noticed a difference in the kids--they look healthier.
"We saw a child who fell into boiling water over the cooking fire. His arm was black from the forearm down. It was ulcerated and pus-filled. His grandmother said it had been like that for three weeks. I asked, 'Why didn't you take him to the hospital?' The grandmother said she was too weak to carry him all the way to the hospital. His arm had to be amputated, but he lived.
"Haiti is an hour and 15 minutes by airplane from Miami, but the country is forgotten. We all realize that we touch the very top surface of the misery, suffering, and pain. But if I can take care of even a few people, it gives me a sense of peace and happiness. They thank me profusely. You hear that and can't help coming back. You impact the lives of these people--not in a big way that you make them rich, but you make them healthier."
As a chemist in the FDA's Kansas City District laboratory, David Foran analyzes food samples to help ensure that the public is not exposed to unhealthy levels of metals in food. After work, the chemist becomes a caseworker for the Red Cross year-round, and in the winter, an Outdoor Emergency Care (OEC) technician on the slopes of the local ski area.
As a caseworker, Foran is called upon to provide emergency relief after national disasters. He was on the first commercial flight into New York City after the terrorist attack on Sept. 11, 2001, and was part of the relief crew in Florida after Hurricane Katrina hit in 2005. Foran also works cases closer to home, helping families deal with tragedies, such as house fires, in the Kansas City area.
"We may get a phone call any time of the night. By the time we're called and arrive, the fire department has already been there, the fire's out, and the family is wondering what to do next. That's where we come in. We assess the damage, in general, and their immediate emergency needs.
"Sometimes people are in shock. We help them think through the process of what they need to do, and help them make the phone calls. Some are upset because 'my TV's ruined,' but we don't deal with that. We're concerned with whether they have the basic emergency needs of food, clothing, and shelter. If they don't have a place to stay, we find a hotel for them. If they need food or clothing, we give them vouchers to use at certain participating vendors. Then we go home and get a few hours' sleep before getting up to go to work the next day.
"From about mid-December to mid-March, I'm on the ski patrol at a small ski resort north of Kansas City. I do about one shift every other weekend. What happens on a shift is totally unpredictable. I could be on the slopes a whole day with nothing at all happening, or there could be five or six injuries in an hour. The majority are pretty minor.
"Rarely there's a serious injury where you need to get someone Life-Flighted out. But when bad accidents happen, it's usually because they violated the Skier Responsibility Code; for example, they weren't skiing under control. I saw a kid after a 360-degree flip who landed and hit the back of his neck. He was in a clearly marked area for advanced skiers only, and he was not skiing in control. I understand he ended up partially paralyzed.
"In the skiing off-season, I'm one of the instructors in advanced first aid. We are essentially non-urban EMTs--emergency medical technicians. Our medical training puts more emphasis on cold and outdoor environments. Teaching it is a good way for me to refresh. The medical text is over 700 pages. We cover everything from how the circulatory system works, to how to apply a splint to a femur fracture, and much more. Some of it is lecture, but a lot is hands-on training, such as lift evacuation. We practice how to get people out of ski lifts if the lifts fail. You have to manually take them down with ropes and lines.
"I volunteer because I get a certain enjoyment and satisfaction out of it. You're doing something to help people, they can't pay you back, and you don't want the payback. It's frustrating at times, but most of the time it's very satisfying."
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