Mark A. Snyder, MD, is passionate about bringing the best possible outcomes to his total hip and knee replacement patients. His expertise is sought worldwide, and he has been a guest lecturer and professor on several continents and throughout the U.S. Among his most significant achievements is directing the Orthopedic... more
LEAD Magazine: What inspired you to do this type of work?
Dr. Snyder: I have always done mission work as part of the practice of being a Christian. I have done work with groups like Christian Medical and Dental Associates and Christian Hands in Action out of El Paso, Texas. It wasn’t until I had to fall on my knees in 2010 and beg the Lord to give me an insight that I could find no where else in medicine, as to how to radically change surgical process for adverse event reduction. This clinical science innovation later on led to the medical mission work our foundation now does throughout the world.
After this crying out for help to get an inspiration that would lead to real health care innovation, on March 25, 2010, the Lord awakened me in the middle of the night to analyze these problems with a simple three step process called “Before, During and After”; and this later morphed into a program called Zero in on Zero. It essentially began simply asking for game changing solutions for well recognized total joint replacement problems like how to avoid blood transfusion or a surgical infection. Newly queried was what mitigable heath risks are present in that patient before surgery, what could be done differently during surgery to reduce their risk and what can continue after surgery,
during their recovery, to further drop the risk. And when these three questions were asked in the same way about 10 major problems including falls in the hospital, blood transfusions, blood clots, surgical infections, total hip dislocations, patient dissatisfaction with their result, poor pain management, poor discharge handoff situations that something remarkable began to happen.
When the same way to solve the problems was used for all 10, synergistic power occurred that created a result that is now virtually 10 times better than U.S. average. This radical improvement has nothing to do with my surgical skill or ability. I’m experienced and I know what I am doing, but this has to do with things that go beyond a doctor’s license, their expertise or even their best efforts, into process improvements and problem-solving methods that can then be integrated into a health care system where doctors perform total joint replacement surgery. There have been national efforts to take on one problem at a time, whether it is infection or pain control, but the problem is that these strong consensus efforts generate huge documents and cumbersome analyses that are difficult to translate into simple practice solutions in a hospital or in a doctor’s practice.
So Zero in on Zero, instead, creates a single page summary for every one of these problems that can be followed on a cell phone or simply executed in a health care system when embedded in their clinical pathways. So now when I do surgery, I still do it with, I hope, good care and skill and do it for the right reasons, but this large process improvement now surrounds and makes so much more safe the necessary joint reconstruction surgery. As a result, this ten-fold
education in complications, readmission and very adverse events that can harm people is registry proven and available to any doctor and health system.
Now, how does this relate to missions?
On August 29, 2012 I was awakened again at night with an insight to take this scientific method and apply it to world health. The interest that I had had for a long time was neglected tropical diseases that affect almost 1.5 billion people. These diseases occur due to worms and other parasites. These diseases ravage mankind, especially in the 10/40 window where there is great poverty. These diseases are a major cause of poverty. I increasingly cared about this topic, and we had an opportunity for my oldest son to use his NGO experiences in Habitat for Humanity and other poverty improving efforts. I called him and said “David, here is an opportunity. Would you want to lead this with me?” He said that yes he would (smile).
So all 6’8” of him, with a great heart and passion to be a good networker with people, moved his family to Cincinnati and started, without any guarantee that it would ever work. Then, we formalized an association with a great worldwide ministry called Burnham Ministry International (BMI), that is one of the top training, non-governmental organizations in the world. In fact, they got a second place award for world-wide mission efficiency a few years ago. By doing this training, at low cost but at high value, their expertise essentially propelled our efforts. The BMI founder is a good friend of mine, Dr. Jonathan Burnham.
Another thing that happened is, when these ideas came together, I had an opportunity to garner a sizable investment that provided a large source of resources to start this foundation. So hopefully for a few years to come, the administrative costs are entirely covered by this resource. What we did then was to take the Zero in on Zero scientific method and see if it could have any impact on world health. We prayerfully considered that we would tackle some of the major challenges in world health like malaria, leprosy, worms, and other parasites. We invented a simple “before, during, and after” method (similar to the clinical science discovery) that could be taught in a village so the villagers could better solve their own health care problems; so they could heal themselves in a way. And how we did it was that we spent a lot of time with expert help and consulted with some very well known, Christian and Christian health care leaders who heard about the idea and said “I think I want to be behind this”. We had a lot of help writing curriculum. We wrote world class teaching that can be used as a Grand Rounds any place in the world, on leprosy, ascariasis, filariasis, lymphatic filariasis, any number of these terrible diseases. That teaching is done in such a way that it is well annotated with best citations and then at the end of each one of these Grand Rounds style presentations, there is a single page summary, “before, during and after” of what can happen in a village.
We combined that with four fundamental Christian teachings, so these are part of the course, too. They have to do with suffering - does God care? That is a very important question around these issues. Most people would say, no, he doesn’t if I am suffering like this. The second one is to establish the divinity of Christ powerfully revealed in the crucifixion; that the crucifixion itself assures that He is actually God. And then we similarly teach about the bodily resurrection in the same way, since that is the cornerstone of Christian faith. And we consider prayer … how does it really work? What did God say it should be like? What can be done in and through prayer? Not in a way that many well intentioned organizations have done, where they will go into Africa and say “let’s name it and claim it.” Our teaching on prayer is actually biblical, authentic, and filled with rigorous questions about what the bible really says about what can really be done in prayer.
So the faith topics are taught with the courses that are medical and scientific in nature. Those that attend the courses; the pastors, the doctors, the health care leaders in these countries then go back to their districts; back to their villages and something wonderful begins to happen. We started in Uganda and Kenya first and have expanded into Rwanda; and next year we will add Zambia and Ghana on the west side.
We have already been to India and when these courses are given. Those that attend can help change a village. Whether it is a catholic church or a protestant group, it doesn’t matter. When the villagers and the village leaders see pastors and doctors, and other trained health care workers come to them with solutions so simple that the village could do it, they start doing it. This is an almost first in history occurrence.
The world has done a good job; World Health and the Gates Foundation and others provide money and resources for drug distribution for many of these diseases. Yet the hardest thing of all is teach the villagers to solve their own problems in a sustainable way since they may or may not even have access to those medications. When you have the medications, our holistic approach is more successful for sure. Just last year, as a result of these efforts, in the third year of our foundation’s existence, over 205,000 people were newly diagnosed and treated in some African countries, in a way that follows this medical and faith enabled problem solving village format. This is teaching fishermen to fish. That is exactly what it is.
We have an open platform website. We give away the teaching for free. We are a significant granting NGO in America. To be a large granting foundation in America, you don’t need to give a lot of money because there aren’t many who give international grants for education, research, and community betterment. We give grants that actually can allow faith and medical leaders in these countries to get further training or support research programs in their villages or their districts to imbed these ways of solving entrenched problems. We are blessed, after just two years of existence, to hire a fulltime African continental leader, who himself survived the Rwandan genocide by escaping under the slaughtered bodies of his family members. Through God’s miraculous grace he eventually found himself leading some of the reconciliation efforts in Rwanda. Pastor Emmanuel is our African continental leader.
Happily we just hired a leader in India, Pastor Biswah, who is actually a modern day Peter or Paul in terms of what he has survived and been willing to do for the faith as he ministers to people and survives threats against his life - even guns to his head. He is actually the one who will lead this program in India.
The Sustainable Medical Missions program is now mature enough that it can be carried out anywhere in the world. At some point we hope to extend into Southeast Asia where BMI’s work is so successful. We try to go deep before we go wide; and we try to make sure that we have continental leaders who can carry this work forward. We have enough training visits, two or three usually, to have the program established in the hands of the nationals to carry it out themselves. And that is basically Sustainable Medical Missions. The website where this can all be viewed, in terms of its content, is sustainablemed.org. We have an open platform. We are happy to let everyone use it.
When we did the leprosy curriculum, I actually worked with the American Leprosy Mission since they are much more knowledgeable and experienced than I. We wanted to create a curriculum that would work in India. With their help and their constructive criticism, this SMM leprosy curriculum emerged. Additionally we have produced curriculum and simple village-enabled solutions for the diseases that affect almost a billion and a half people - ascariasis, roundworm infestation. This is really exciting!
What is happening now, out in these villages and districts where these programs get deeply rooted, is that the churches are overflowing with people eager to attend. Now the biggest problem is not enough churches, not enough buildings. We have actually started a select building program called Life Centers, for some of our established partners. For $2000 a Life Center can be funded. It is then built with the sweat equity of the villagers to create a structure for church, for health care teaching and for women’s education, for child rearing help and any number of things. Not only have many of the Life Centers started, but we are actually beginning a Center of Excellence program where, in certain districts and with certain leaders that are nationals, the program can be so well taught and established that nationals are sufficient leaders of the Center of Excellence to propagate for decades. And this is all part of Sustainable Medical Missions.
So this is not a typical story about a doctor doing missions. It is that I have had the privilege of teaching young national leaders and pastors. I am privileged to learn from them. Under their guidance we walked through the villages and saw something so basic as the lack of latrines. We are blessed to have witnessed a latrine built, under our funds, to help an entire school district. In these kind of cost-effective efforts, Christian and medical education novel approaches help better solve world-wide scourges. I like to say that Christianity without compassion is not Christianity. Jesus, when he was with us incarnate, his work was great news through His and teaching and miracles. In Christ God is with us and He knows our sufferings because He came right down into them with us. Christ performed many miracles, and many more occurred than were recorded as John explains in his gospel. Almost half of these were medical miracles. I think it is safe to say that the gospel that Jesus taught, without compassion, is not the gospel that Jesus taught. We like that to be very characteristic of what we do. We honor His healing. We depend on His grace. Through Him we care for those who the world would regard as the “least” among us.
LM: So your son is the director of Sustainable Medical Missions?
DS: My son is the Executive Director of our public 501©3 nongovernmental organization. We have a wonderfully active board. This year, over 130 different people gave us financial gifts to support the ministry work - people all the way from Seattle to South Carolina to communities where very generous people have supported this work. The generosity has nothing to do with the dollar amount. We have had people give us gifts that let us write brochures to explain the program. We have partnerships with agencies like Caring Partners International and Call of Love ministry and Burnham Ministry International, American Leprosy Mission and on and on. We really need to be partners, not competitors with those who are doing equally good and important work.
LM: Are you not specifically doing orthopedic surgery in these places?
DS: No, because the need is so much greater for neglected diseases and neglected people. The need is so much greater than the joint reconstructive work I so dearly love to perform. I do still travel around the world, usually with sponsorship from a company such as Smith & Nephew to do demonstration surgeries and total joint replacements. I have been blessed to visit most of the countries in the world.
LM: What has been your favorite place?
DS: I would say China. The reason is two-fold. One, in China you get a “license” to be an orthopedic surgeon with varying levels of training. So when I went there and demonstrated a total knee replacement, their response was “We have never seen a perfect total knee.” That tells you that they are not adequately trained to do it. There are many good surgeons there, but it is a level of training that is still quite primitive, in some respects. Second is I have shared my faith in China and many other places where it is difficult to do that. People at dinners and conferences ask me about the United States and they ask me about Christianity. So, without any regard for what could happen, I openly shared. They were very warm and generous about receiving it.
LM: What have you learned by doing this work?
DS: I have learned three big things. Number one, that it is always a good idea to fall on your knee and beg the Lord to help because out of that comes a richness of discovery and innovation that can lead to some of these things. The second thing is that I’ve learned that the great lie in the world is that the poorest of people and the most desperate, would not help themselves if they were given the tools to do it. I’ve heard that from many famous agencies and governments. We’ve discovered that is not true. That is a lie and when they are given the right tools it makes sense in light of their own resources and capacity for change; and they will do it. And then number three is that I have increasingly learned that the beauty of the good news of the gospel is that people like me, who deserve nothing, can always in Christ, find healing and hope and usefulness. Even more, I know we were made for eternity with the God who created us and saved us.
LM: Would you like to continue this work, as long as you are able?
DS: I plan to continue to do total joint surgery until age 70 but I increasingly give time and resources to this medical mission work. As long as Trihealth will allow me, I will continue to do both orthopedic surgery and do clinical translatable research. l will increasingly be involved in Sustainable Medical Missions if the Lord continues to give to this foundation, which is needed every year. Every year a foundation must seek funds, really, unless you get an endowment somehow. You have to continue to have a story that is convincing and honest and challenging in order for people to want to support it. We plan to let this spread all over the world but do it in a way that lets us be out of the picture in three plus years. Wherever we go we want the fame be for the Lord, and for the people themselves who can carry it out to their credit and for their benefit.
LM: What message would you like to share with our readers? What is the take away?
DS: I want the people to realize that there are process improvements in life; in medicine, in science and many other areas that could change everything. I want them to realize that these process improvements can be used anywhere in the world to affect horribly common problems. I want them to know that the essence of innovation and discovery is crying out for help, opening your eyes to see what is happening, and asking why it happens so that you would discover new solutions. If those three steps are taken, everything can change. To God be the glory!
For photos and more info, contact David Snyder, the executive director.