Lani Ackerman, MD, (center) in Nepal with women who were raised in the orphanage and graduated through the HELP program.
Member of the Month: Lani Ackerman, MD
Texas physician works internationally to transform lives and communities
By Kate Alfano
Lani Ackerman, MD, has spent most of her career answering the call to serve the poor internationally, as well as training family medicine residents and students in the U.S. and Asia. In addition to treating patients, during their eight years of volunteer service in the Himalayas, she and her husband founded a non-profit community development organization and orphanage in Nepal. Health Environmental and Learning Program (HELP) empowers nationals through “trainer of trainers” programs by teaching Nepalese in areas of health, agriculture, veterinary medicine, environment, income generation and literacy.
Her adventures are numerous and she recounts some of them in her book, Ke Garne?: Sustainable Christian Community Development in the Himalayas, (available on Amazon). Currently she continues the work in Nepal while building a family medicine department and a family medicine training program in China.
Though her path has not been easy and she struggled at one point to survive the dark days of total “burnout,” she draws strength and joy from her faith and her family. Within the next two years, once her project in China is well established, she plans to return to an academic position at a Texas medical school or residency to be closer to her young adult children.
Who or what inspired you to become a physician?
My personal Christian faith and desire to be the hands and feet of Christ helping people physically and spiritually in areas of the world without health care are what inspired me to be a family doctor. My family doctor in College Station, Texas, Lamar McNew, MD, and my grandparents’ doctor in Jasper, Texas, Joe Dickerson, MD, both served as role models for me as true family doctors who cared for those in the community regardless of their ability to pay.
Can you briefly describe your career path?
The short answer is that my career has not been a smooth path; I have done just about everything a family physician can do — teaching, private practice, clinic, hospitalist service, obstetrics, public health, and more. Fortunately there have been periods of immense joy as I followed my heart’s desire to serve the poor internationally but unfortunately there was a difficult period when I suffered from complete burnout.
In 1988 I married an equally adventuresome ecologist from Colorado and, following several years on faculty at John Peter Smith where I had completed my residency, we moved to the Himalayas. Our two years in Bhutan were an amazing adventure of diagnosing and treating patients of all ages while establishing a training program for young doctors. I was on 24-7 call, but the hardest part was seeing my residents sent away to refugee camps due to a national ethnic cleansing. Because of political instability, the project ended and we returned to Fort Worth where I again joined the JPS faculty for five more years, practicing full-scope family medicine. Inspired to teach my Texas residents global health, with the support of our program director, we developed the JPSH international health track and clinic, which is today a nationally acclaimed global health fellowship within the residency.
In 1997, we had the opportunity to return as volunteers to the Himalayas, this time to Nepal. Living in a rural village in a mud house, I had the opportunity to understand the hardships of the villagers and learn the language and culture well. Despite my training, I realized my curative skills as a doctor were useless to change the problems of malnutrition, illiteracy, neonatal and maternal deaths, gender discrimination, domestic abuse, and more. With the worsening revolution, we moved to a more developed town to join a visionary Nepali doctor as he built a community hospital and served as both a teacher to young doctors and the consultant for maternal-child health. Again, caring for illnesses in their last stages convinced me of the need to address the root of the health problems, rather than simply the end result. Because of my academic background, I was then asked to join Nepali colleagues to start a new medical school in the area using problem-based learning approach and for the following two years taught physical diagnosis, community medicine, public health and more. I am delighted that this medical school is still doing well, and many of my students are excellent physicians in Nepal and other countries.
In addition to the stresses of work and daily life, our four children were getting older and home schooling was getting more time consuming. In addition, my husband and I had founded a grassroots community development organization training local Nepalese in health, agriculture, veterinary medicine and literacy that became a non-governmental organization funded through our non-profit Health Environmental and Learning Program (HELP; www.missionforhelp.org). This was in addition to our “official” work. The Maoist insurgency increased resulting in more abandoned and orphaned children. With the financial assistance of donors and the physical help of our kids (as teachers and playmates), we began an orphanage for abandoned children. Finally, our finances were so stretched and our oldest daughter nearing high school age, that we made the decision to return to the U.S. and continue as volunteer administrators. By earning income we could provide better funding for the HELP’s expanding projects, as well as better educate our children.
As an aside, in the past 20 years with our Nepali partners, HELP has literated more than 21,000 women, trained thousands of farmers in veterinary and agriculture techniques, taught hundreds of traditional birth assistants, provided clean water and sanitation, assisted communities through economic development, and decreased maternal mortality. For me, this privilege of teaching and empowering others has been and continues to be even more rewarding than my practice of curative medicine in Nepal.
Back to my career journey: The two years following our return to the U.S. were a difficult re-entry into medicine for me. I joined a practice near my parents in South Texas. Due to dishonest partners and my lack of business sense, I found myself working 80-hour weeks (clinic, obstetrics and hospital) but not getting paid for six months. My mentor, Dr. McNew, recruited me to return and teach in the family medicine residency in College Station and helped me to become re-credentialed in C-sections. Soon, however, with pressures of administrating and fundraising for our growing mission in Nepal and home schooling the younger children with my husband, I needed more family time. Like many women, I had to choose between the type of medicine I loved and a balance with my life — so I accepted a different job in College Station in a multispecialty clinic, also teaching as an associate professor at Texas A&M medical school, my alma-mater. Meanwhile, my husband developed health issues related to a hip replacement and later developed severe complications from the metal-on-metal hip implant.
By then, I was missing the challenges of teaching residents and tired of the corporate pressure for higher clinic production and RVUs. A friend of my former program director while on faculty at JPSH had started the only residency in Alaska and needed a good academic and associate program director. The next three years were full of wonderful practice and teaching experiences, training family medicine doctors to work in resource-challenged environments in rural Alaska.
Again, family responsibilities prompted a change and move. Because of my father’s ailing health, I accepted a position as program director of a family medicine residency program in west Texas. This was one of the most challenging times of my life. Despite my expanding and improving the program, I resigned after a year due to poor leadership communication, concurrent with my complete exhaustion from the journey through hospice with my father. Our oldest daughter was in dental school; two were in university and one was in high school. I was disillusioned, tired and ready to quit medicine, but needed to support our family as well as our children at the orphanage and nonprofit organization in Nepal. Out of financial necessity, I became a hospitalist in the same area and worked in that capacity until I recovered enough to re-energize my love for teaching and global health. Then, I accepted my current position in China — one offered nearly two years before.
What are you currently working on?
Currently, as department chair I am building a family medicine department and a three-campus family medicine training program in China in a new hospital run by a large and well-established U.S.-Chinese network. My patients are both expatriate and Chinese. Though family medicine is new here, the government has mandated a primary care physician for every person by 2021 and there is a huge incentive to produce family doctors. Unfortunately, most patients and doctors do not know what family medicine is and even leaders trying to set up training programs are challenged by unclear objectives. In addition to improving our family medicine program, a private one, more exciting are the opportunities I have to train other family medicine department chairs and assist my Chinese colleagues in developing government training programs for general practitioners that will impact this whole region of China.
What brings you joy in your work?
Though I love the joy of watching patients stay healthy and recover from illness, my greatest joy is teaching others. First, I love watching students and residents learn how to care for patients with compassion and competency. Secondly, my great passion and joy is being a part of teaching others to change their communities and seeing the continued work in Nepal in which I continue to participate. For example, a few years ago on a return trip to Nepal, I had the chance to give a graduation speech to prisoners who had completed our literacy program in an area where we had been working for years. Due to the community transformation people no longer needed to send their daughters into prostitution, and even the prisoners who had been traffickers had their hearts changed by God through learning to read and write. That is so much more than a prescription can do; it is hundreds of lives over and over being transformed. We use academic terms — social determinants of health, gender equality, population health and more — but in my humble opinion, holistic medicine is following the example of the compassion of Christ, ministering to the body, soul and spirit.
My own family brings me great joy in my life and keeps me going. I have a great husband and four amazing young adult children, two of whom were recently married. I recently returned for a reunion and deeply appreciate my Nepali “kids” who are now grown plus the new ones who come. Hearing how they love God, each other and their neighbors brings me greater joy than having seen them recover from worms, leprosy, malnutrition and typhoid fever.
Ackerman’s "Nepali 'kids'" at reunion in Nepal, June 2019.
What should people know about international practice that they might not know?
Honestly, the days of short-term medical missions is over. Most countries have their own doctors and do not want our short-term groups. Instead, we need to focus on how to support our family medicine colleagues in less developed countries through training and education. In addition, we can financially support grassroots work, which is more effective than curative “health camps” through community development. To have an impact long-term internationally requires huge personal, physical and financial sacrifices. In addition, there are many international opportunities in our own “backyard” which many family doctors are involved in — refugee and immigrant health or just caring for our own who have less access.
Can you describe an adventure you have had?
One I won’t forget happened many years ago. In the middle of the night when my husband away in the mountains for his work, my neighbor across the field ran over to ask for help with a woman who just delivered a baby. I had three kids under five and was pregnant, too. While another neighbor stayed with my three, I ran across the rice paddies in the dark, anticipating it was too late. In the hut I found a woman lying on a mat, unresponsive, with a thready pulse. There was blood everywhere and the newborn baby was screaming. I grabbed some gloves but the mother-in-law (who had done the delivery) grabbed my arm and said, “you can’t touch her, she is unclean.” I pushed her away, donned my gloves and after evacuating the clots began vigorous uterine massage combined with fervent prayers for this woman’s life. “It was the fourth girl,” her mother-in-law said in disgust — “still no boy.” The bleeding stopped, the uterus became firm and we laid her on a stretcher used for carrying bodies to cremation. Some men with her husband carried her to our project clinic where we had an IV and, after a liter of saline, her blood pressure was palpable and she awoke. With much difficulty, as she had not had a son, I convinced the family to send her to a hospital with a blood bank many hours away. Now, due to the hard work of HELP and others, those same areas have trained workers and oxytocin to prevent these outcomes. I’m so glad to have a small part in working with my Nepali brothers and sisters to make a difference.
Your adventures as a doctor are amazing. Can you talk about what was it like to birth four kids and parent them away from your native culture?
The struggle to raise four kids (plus the ones in the orphanage) was not and is not easy. Two of my children almost died from asthma; one had a traumatic hyphema and supracondylar fracture. It certainly increased my parental anxiety and prayers. We had to home school for six years in Nepal and continued to in the U.S., both because we enjoyed it and because the children initially adjusted better. Home schooling, however, was quite difficult for me when we returned to the U.S. as I was working such long hours, but my husband was a “Mr. Mom,” and we made it work. Honestly, I think it was much harder bringing up the children when we returned to the U.S. than in Nepal, as in the U.S. there are dangers more damaging than infectious diseases, war and environmental dangers. Our oldest two are the most “third-culture kids” — kids who identify with more than one culture, but all four have great cultural competency, as we call it in medical education. They have taught me a ton, too, and now one of my areas of practice focus is children in the international community whose parents are from two different countries, living in yet a third country. I’m from the older generation of women — we did not have any role models and were taught to put the patient before our own needs because medicine is to take priority over everything, including family and children. I am still trying to find that balance and hope by the time I have grandchildren I will figure it out!
TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at email@example.com or by phone at (512) 329-8666. View past Members of the Month here.