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On the Road to World Health

September 23, 1988|JOSEPH N. BELL

He had just arrived home from Mexico an hour before I got there, a trip he makes at least once a month and frequently much more often. He had left by car on Thursday afternoon after three 12-hour days of seeing to his Orange County practice.

Along with a pediatrician associate and a visiting nurse (usually several UC Irvine medical students go along, as well), he had spent the weekend running a medical clinic for an obscure band of Mexican Indians near Ensenada who basically have no other health care. Tomorrow he would be meeting his local patients again.

A normal week in the life of Dr. Dennis Mull.

If he was fatigued by this regimen, he certainly didn't show it on this Sunday night. At 50, a round-faced, slightly rotund man with warm, ingenuous eyes behind rimless glasses, Mull manages to combine a kind of favorite-uncle kindliness with a powerful sense that he knows what he is talking about--and believes in it.

"Besides the clinic for the Indians," he says, "we have two other ongoing projects in Mexico: a weight program for children outside Tijuana to see if they are properly nourished, and a program to limit the spread of AIDS on the Mexican side of the border."

Medical students have been especially helpful with the latter program. AIDS, says Mull, is mostly brought to Mexico from the United States and transmitted through Mexican prostitutes. Since prostitution is a flourishing industry in Mexico, the dangers are high. Mull's medical students are interviewing prostitutes, trying to discover local attitudes and practices to permit more effective preventive treatment. It is a technique that Mull helped pioneer, then developed for attacking health problems in Third World countries.

His partner in that effort is his wife, Dorothy, who stayed home on this weekend. A tall, articulate, self-assured woman, she holds a doctorate in English and was a specialist in Shakespeare until she turned to anthropology a decade ago so she could study the social aspects of medicine in tandem with her husband.

They live in a tract home in Irvine with their three children: Brenden, 14, Justin, 11, and Ashley, 9. The house, decorated with artifacts from their extended trips to Saudi Arabia, Pakistan and Latin America, reflects their priorities. Its focal point is the word processor console in the breakfast room, where Dorothy works on the papers summarizing their research. "We haven't totally moved in yet," she explains, "since we got back from Pakistan."

That was several months ago--a year's sabbatical that turned into a two-year tour of duty (the second one unpaid). The objective: establishing a public-health program at a new university hospital in Karachi and doing extensive anthropological research. Says Mull: "We have to know what health behaviors are in a community before we can know the nature of the problem--and find the best route to change."

He brandished a tiny packet that was labeled "Oral Rehydration Salts." "This costs 3 or 4 cents to make," he said. "Yet it could cut down dramatically on the 5 million kids who die every year of diarrhea in Third World countries--300,000 in Pakistan alone. But that knowledge is almost useless unless we first learn what mothers think and do about diarrhea before we start a health campaign to advance the use of oral rehydration therapy."

He must have made that point dramatically in Karachi. Shortly after Mull returned home, Ray Martin, chief of health population and nutrition for the U.S. mission to Pakistan, wrote him: "There is a tendency from program managers to think they know what and how people think and how best to implement training and communication programs. Your research may well challenge some of the conventional wisdom and lead to more effective programs."

Dennis Mull didn't arrive at that point either quickly or by a conventional route. He was raised in Clinton, Iowa, the son of a sales executive who moved frequently. As a Harvard undergraduate, Mull's interest in writing influenced him to major in English; he switched to premed "because I thought it would be a gratifying experience. But it was always the social side of medicine that interested me."

He had finished medical school and was interning in Richmond, Va., when the Army sent him to Vietnam. That is where he began to form his views on anthropological medicine. He was assigned to help Vietnamese civilians in a clinic in the interior of northern Vietnam that was frequently under fire. "When I first went there," he says, "I thought (the war) was something we had to do, but when I saw the people I was treating getting kicked around by both sides, I grew to believe that it was a big mistake."

During the Tet offensive, Mull's clinic came under attack, and one of his medical corpsmen was killed by a sniper. Mull wrote a touching letter to the man's family and received a grateful answer from the man's sister. Her name was Dorothy Sipe, and she was an English professor at the University of Wisconsin.

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