Medical Missionary of Mary Sister Maura O'Donohue, a native of Ireland, is a physician and an expert on tuberculosis — an infectious disease that is threatening to make a comeback in the industrialized world. She is responsible for allocating approximately $40 million worth of medicine to some four dozen countries each year. Her efforts largely depend on the generosity of American pharmaceutical companies. Recently she spoke to Register correspondent Joop Koopman.

Born: March 2, 1933 in Kilfenora, County Clare; one of four siblings.

Current position: Director of programming for the Catholic Medical Missionary Board, Inc. (CMMB), a non-profit international medical relief agency based in New York.

Background: Medical doctor; joined the Medical Missionaries of Mary in college; spent nearly 20 years working mainly in Ethiopia; joined the Catholic Fund for Overseas Development (CAFOD) — the official international relief arm of the British bishops — after terms in Nigeria, Kenya, Sudan, and Ethiopia; an expert on HIV-AIDS; specialized in endocrinology and cardiology and has a master's degree in international community health.

A Catholic medical doctor, consecrated religious, and veteran foreign missionary explains the successes and travails of contending with illness in underdeveloped lands

Koopman: With the recent breakthrough in Northern Ireland, readers will be interested to hear about your father, Andrew O'Donohue, who fought, alongside Michael Collins, against the British.

Sister O'Donohue: As a young teenager, my father was involved with what might be called the old Irish Republican Army — the Irish Brotherhood. They fought for independence until 1921, when the treaty with Britain was signed.

The treaty gave 26 counties of the 32 counties independence. This caused a break within the ranks, as there were those who wanted complete independence. In the wake of this turmoil, my father opted out. He was pro-Collins at the time and felt that the Irish hero did the best he could at the time.

Did you grow up in a militant household?

No, not militant. My parents preferred to remain silent on the issue, which was very divisive at the time — even splitting families. In fact, the schools did not teach about the treaty, the Easter Rising or any of the events of the war for independence. It was such a difficult issue that, both in public and in the homes, silence was observed.

Of course, my father had a keen interest in the political developments of the time. He would have been very happy about the civil rights movement in the Republic and the North, which was the precursor of The Troubles, and the present events. Catholics were denied rights from the 1920s onward. Catholics were kept down in the counties that had not gained independence. It is to be hoped that the current treaty will be respected by all parties and lead to genuine peace.

Please tell us about the Medical Missionaries of Mary. Who was the founder?

Mary Martin, an Irish woman from Dublin, who was educated in England. She was one of 12 siblings. She died in 1975. Given our meager resources, a canonization process is unlikely. We number about 450 sisters today; we are small, in part because we have focused on medical care.

Some 8% to 10% of us are medical doctors; then there are nurses, nutritionists, hospital administrators, etc. We now have members from Ireland, the United Kingdom, the United States, Germany, France, Italy, and the Czech Republic. But the biggest growth today is in Nigeria, Kenya, Tanzania, and Uganda. Sister Philomena Sheerin, a social worker, is our current mother superior. She is based in Dublin.

You were a teenager when you first considered a vocation. At the end of high school I first began considering becoming a sister; I also had a strong interest in the health-care needs of the poor in the developing world. I had seen films and heard testimonies by returning missionaries.

In those days, the Irish Church produced many missionaries, who went throughout the country telling the young about their work. These men and women had quite an influence — and St. Thérése, my favorite saint, was patroness of the missions.

I started medical school, interrupted my studies to enter the novitiate, finished my degree, making my final commitment to the Medical Missionaries of Mary in 1959, when I was already in Nigeria. I would spend nearly 20 years in the mission. Malaria forced me out of Nigeria after a few years. I ended up spending nearly 14 years in revolutionary Ethiopia, where socialist experimentation, warfare, and drought conspired to cause terrible famine.

Was your life ever threatened?

I was an administrator of a hospital and the socialist regime looked on everyone in authority as the enemy. Bands of youth were sent out to “agitate” people across the country, and a group took over a wing of the hospital. I was forced to sit in on weekly, excruciatingly long and tedious meetings. These student-agitators egged on the locals to begin clamoring for free health care, accusing the hospital of exploiting the people. On a few occasions, my staff and I were forced to flee the area to escape an angry mob.

What stands out most in your memory of your years in Ethiopia?

Dealing with the victims of famine. Almost on a daily basis, dealing with extremely limited supplies. During certain stretches of time, I had to walk among rows of starving families — mothers and children — having to determine who would not survive another day without food, and who could. The latter would be passed over.

You also spent time in Sudan in the mid-'80s. What were your experiences there?

I did some work for the bishops’ conference there, evaluating Church-related health programs. At first, I thought Sudan would be a relief after Ethiopia, but things were even worse there. The regime was more brutal. Christians who came North were dealt with very harshly.

There are brutal regimes around the world, but the West deserves some of the blame for not intervening more effectively.

At the Catholic Fund for Overseas Development (CAFOD) you were responsible for HIV-AIDS programs. Has the Church reacted quickly enough to that crisis?

The Church was slow to get involved, but so was society generally. The Church has since responded effectively and appropriately in many ways. Its infrastructure in the poorer countries, for example, has been mobilized.

At the Catholic Medical Mission Board (CMMB), you have embarked on an ambitious program that would help the organization be more proactive — more focused. Can you explain?

Traditionally, CMMB has sent a wide variety of medicines to countries; I was a highly appreciative recipient of many such shipments. That is a terrific thing, but I wanted to add more targeted programs. One of the problems is that a particular hospital might get a particular consignment of medicine to help things along for one year; however, the next two or three years nothing may come. That makes it difficult to plan, and dilutes the impact CMMB could have. If we focus more on fewer facilities, for example, or fewer countries, we can make sure that supplies are consistent and that treatments can be sustained from start to finish.

Of course, we will also continue our traditional efforts. An example is our current three-year de-worming project in Central America. At the end of that period, we can be reasonably sure that 1.5 million children will be rid of intestinal parasites, a success that can be achieved thanks also to accompanying educational efforts that stress hygiene, etc.

In Central America, you teamed up with Johnson & Johnson.

Yes, the company is producing the medicine needed for free and specifically for that project. What's more, Johnson & Johnson is willing to consider taking the program elsewhere, now that our joint efforts in Guatemala, Nicaragua, Honduras, and El Salvador are turning out to be so successful.

Allow me to use this occasion to praise the U.S. pharmaceuticals who have so generously come to the aid of the sick around the world. While abuses have occurred — and bad or expired medicine has been dumped in places like Bosnia and Armenia — our experience with the drug companies has been overwhelmingly positive.

These companies don't just give to get tax breaks. While there are fiscal advantages, there are hidden costs the public never hears about, such as those incurred by maintaining an international donation department, as well as shipping donated medicine to our warehouse.

What other diseases do you hope to target?

Tuberculosis (TB) is high on the list. The World Health Organization (WHO) predicts that more than 300 million people will become infected in the next decade; 30 million already-infected individuals will have died by the end of the ‘90s. By 2020, another 70 million are expected to die. In fact, one-third of the world's population is infected with the bacillus. The disease is responsible for no fewer than 26% of avoidable deaths the Third World. TB kills 100,000 children each year.

TB has been proclaimed a global pandemic, and the West is neglecting the problem, because we thought we had it under control once and for all earlier in the century. However, globalization has a downside. Air travel, for example, also allows viruses to travel, and the industrial nations, which have stopped inoculating people, could be hard hit by TB. We thought we had it under control, but there was already a scare here in New York in the ‘80s. HIV-AIDS made all the difference. HIV infection makes people much more vulnerable to TB infection, particularly in the Third World — and HIV-AIDS is already worldwide, of course.

CMMB, at the urging of WHO, has adopted the so-called DOT method for the cure of TB: Directly Observed Treatment. Can you explain?

That method ensures that a patient completes his or her cure. In many instances, an interrupted course of treatment can make the particular strain of TB resistant to medicine, while the patient can go on infecting other people, this time with nearly untreatable forms of TB.

By contrast, for every cured patient, 10 or 15 others will not be infected. We are currently launching a pilot TB program in Zambia. We're hopeful that we will find a pharmaceutical partner for this project, too.

Other priorities?

There is choriocarcinoma, a condition that affects young women of child-bearing age. Treatment costs about $1,000 per patient. That sounds like a lot, but consider that one cancer patient in the West may incur thousands and thousands of dollars of charges — oftentimes only to prolong life. In the Third World, that relatively small amount will bring a mother back to health, and help her be of service to her family and her society.

Anything else you hope to target?

Trachoma, a preventable but often debilitating disease that causes blindness. It occurs in dry, arid regions, where bacteria cause infection under the eye lids. The infection, along with sand and dust, causes scarring of the lining of the eye lids.

Some 10.6 million people suffer from certain complications of the disease, but 146 million have the full-blown disease, mostly living astride the equatorial belt of Africa. Lack of hygiene and water are the main causes, but a new antibiotic, taken once every six months, can cure it completely. The condition does not require much training for health-care personnel, so training is not a major problem.

We have to do more education, not only abroad, but at home, too. We must persuade more pharmaceuticals to partner up with us.

What are your selling points?

We can make use of a unique infrastructure, thanks to our partners, like Catholic Relief Services and the local Caritas agencies in the countries, as well as the local Churches, which allows us to effectively reach even the most outlying areas. We have the advantage of having a direct link to the Churches. That is a spiritual as well as a practical advantage.

In addition, Western governments, and Western societies as a whole, must become more mindful of the difference they can and should make.

How can the wealthy countries become more compassionate? There is compassion, but also self-interest. Consider the fact that one tablet twice a year can prevent a person from going blind, multiply that by millions, and you have an enormous impact on a country economically. There will be fewer people dependent; more able-bodied individuals can help lift a country out of poverty — and that is also an advantage for the West.

A coalition of non-governmental agencies is lobbying the World Bank and the International Monetary Fund to use the occasion of the Jubilee Year 2000 to forgive the debts of the poorest countries. What is the effect of debt repayment on health care?

Countries eager to repay their debts can only allot minimal amounts to healthcare for their own citizens, and more cuts are being made all the time.

Money is so scarce. Imagine, many countries are merely making a small dent in the interest owed on loans. They can never catch up, never hope to build up a healthy economy and society. As part of a vicious circle, the countries affected cannot get any more aid pending their repayment.

Many of the local poor, because they cannot afford to pay, even a little, tend to avoid doctors. They will only come when the situation has become desperate, when a cure may no longer be possible. Or some will begin treatment, but quit as soon as there is even a little improvement, before really being cured.

In the long run, if the West doesn't relent, there is bound to be a backlash somehow. As it stands, a fraction of the world population lives very well at the expense of the great majority. As Christians, we cannot allow such a situation to continue indefinitely.

Why are there so many illnesses?

Illness has been with us from the beginning of time. We can say it is environmental, due to our neglect, etc., but that is not the whole story. It is simply part of life. Suffering is part of life, as the faith teaches us. That's why the Church's social teaching exhorts us to care for the sick.

This spring, the World Health Association is considering new guidelines for drug donations proposed by WHO. One of the provisions would stipulate that medicine arrive in a particular country with no less than 12 months left before the expiration date. That, as well as the exclusion of certain drugs approved by the Federal Drug Administration, has agencies like CMMB concerned. Why?

We are very concerned. There are reasons for the guidelines — there is a need to prevent abuses — but some of the out-dated medicine, studies have shown, has come from small, private pharmacies or was given in emergency situations. Most of those supplies also came from Europe.

We only handle donations from U.S. pharmaceuticals. What's more, the guidelines relate only to donated drugs, not purchased drugs. As it stands, the U.S. pharmaceuticals donate medicine, while the European companies sell medicine in the Third World.

In any case, CMMB prides itself on an excellent delivery system once medicine arrives in a country. We are able to ensure that medicines reach even the most outlying areas before expiry and are used responsibly. If we can only accept drugs with 12 months’ expiration, we are forced to decline a significant portion of medicine that could otherwise help the poor, even though we are confident that we can arrange delivery and use of medicines with much less time left before expiry. Rather than setting such extreme limits, WHO might also consider helping streamline some of the red tape that often delays the distribution of drugs.

The bottom line is this: We applaud WHO's efforts to prevent abuses, but any new guidelines should not deprive the poor of a significant portion of essential, life-saving care.

— Joop Koopman

For further information contact the Catholic Medical Mission Board, 10 West 17th St., New York, NY 10011; tel. 800-678-5659.