Physician Slain in Kabul Was a Gentle Man in a Violent World

May 20, 2014

Pediatrician Jerry Umanos, MD, was a gentle man in a violent world that he knew all too well.

Dr. Umanos spent most of his medical career peering into the ears and mouths of children in one of the roughest, most gang-ridden neighborhoods of Chicago, Illinois. That altruistic service might have sufficed for most physicians, but Dr. Umanos went an extra mile. In recent years, he divided his time between Chicago and Kabul, Afghanistan, where the danger lay not with the Latin Kings and Vice Lords but with the Taliban and its allies. There, at the Cure International Hospital in Kabul, Dr. Umanos peered into the ears and throats of imperiled Afghan children.

On April 24, at the hospital entrance, the 57-year-old Dr. Umanos and 2 other Americans were shot to death by an Afghan police officer gone rogue.

Sen. Dick Durbin (D-IL) paid tribute to the slain pediatrician on the Senate floor. On May 3, roughly 1000 people, including Illinois Governor Pat Quinn, packed a gymnasium for a 2-hour memorial service. The physician with the plucky smile was revered that much.

The late Jerry Umanos, MD. Photo courtesy of Cure International

"His desire to serve others was foremost," said pediatrician Bruce Rowell, MD, chief clinical officer of Lawndale Christian Health Center, where Dr. Umanos worked. "He wanted to go where the need was.

"Jerry loved his neighbors."

Jennifer Martin, a registered nurse who practiced alongside Dr. Umanos for a year in Kabul, offered similar praise.

"He was truly the most gracious man I have ever met," said Martin, a nurse manager at Connecticut Children's Medical Center in Hartford. "From the get-go, you felt like he was your best friend."

A Physician's Physician

Dr. Umanos earned an MD at Wayne State University School of Medicine in Detroit, Michigan, and completed a pediatric residency at Children's Hospital of Michigan. Afterward, he worked in an inner-city clinic in Chicago through the National Health Service Corps and then joined Lawndale Christian Health Center in 1989, said Art Jones, MD, one of its founders. The medical center is a ministry of Lawndale Community Church, which also has spawned housing and educational programs in the Lawndale neighborhood on Chicago's West Side. Dr. Umanos, who became a church member, liked this holistic approach to serving the poor, Dr. Jones told Medscape Medical News.

"He was willing to work for a salary similar to what residents were making," added Dr. Jones, now a principal at the consulting firm Health Management Associates in Chicago.

Dr. Umanos was the first pediatrician Dr. Jones hired at Lawndale Christian Health Center. In addition to treating children who were receiving Medicaid or were uninsured, he also tended to those of clinic employees. "My 2 kids were his patients," Dr. Rowell told Medscape Medical News.

Dr. Rowell described his deceased colleague as a man of "incredible joy" and equally incredible energy. A tennis player and off-road biker, Dr. Umanos would read medical journals and his Bible early in the morning while pedalling a stationary bike.

"He kept up with the pediatric literature better than any pediatrician [I] know," said Dr. Rowell. At the same time, Dr. Umanos was humble enough to ask for help, he said. "He wasn't afraid to seek a second opinion."

Babies Saved, New Physicians Trained

In 2005, Dr. Umanos and his wife Jan Schuitema, a school teacher, traveled to Afghanistan to visit another couple from their church who was working with patients with tuberculosis. For Dr. Umanos, that visit sparked some 8 years of service in Afghanistan, where he spent the bulk of his time up until his death, although he continued to practice at Lawndale Christian Health Center as well. As a physician who wanted to go where the need was, he had discovered a place needier than the West Side of Chicago.

Decades of war and a Taliban insurgency have shattered the nation's infrastructure, leaving a healthcare system in name only. Basic medical equipment and supplies are scarce, and generic drugs from India, China, and other countries are often fake or ineffective, according to the US State Department. "Public hospitals should be avoided," the State Department notes on its Web site. Unregulated private clinics are often operated by individuals lacking a medical degree. Legitimate, Western-style clinics can treat routine problems but "may not be suitable" for heart attacks, strokes, and complex trauma cases

If anyone suffers the most in this ravaged country, it is the children. Afghanistan has an infant mortality rate of 117 deaths per 1000 live births, the highest in the world, according to the Central Intelligence Agency. One third of children younger than 5 years are underweight. Perhaps not surprisingly, 1 in 10 Afghan children do not see their fifth birthday, according to a 2012 estimate from the World Health Organization.

Dr. Umanos strove to give Afghan children more of a chance, despite lacking medical resources taken for granted in US hospitals. When nurse Martin served there in 2008 and 2009, the neonatal intensive care unit had no ventilators or total parenteral nutrition to assist premature babies. Dr. Umanos, she said, addressed the needs of preemies in a more low-tech way, helping to create a "kangaroo room" in which mothers could hold their babies for hours on end. The skin-to-skin contact, she said, promoted weight gain.

"There [were] so many babies who lived because of the vision he had," said Martin.

To better connect with his young patients and their parents, Dr. Umanos learned the country's Dari language. "And he was one of those guys who always had a smile on his face," said Martin. "That works no matter what country you're in."

Dr. Umanos also trained Afghan resident physicians at Cure International. That job posed an extra challenge because Afghan medical school graduates receive mostly a book education with very little bedside experience, said Dr. Jones. Many of the physicians Dr. Umanos taught eventually came back to practice with him at the hospital.

Dr. Umanos had another multiplier effect on healthcare in Afghanistan: Several dozen workers at Lawndale Christian Health Center followed him and his wife to Kabul to serve in short-term mission trips.

"Where He Was Supposed to Be"

During her 1-year stay at Cure International Hospital in Kabul, Martin sometimes heard sounds that persist today: the chatter of small-arms fire, the blast of a suicide bombing.

The violence "was never far from our minds," she said. "We all knew the risks we were taking."

Sometimes the risks stared them in the face. Dr. Jones recalls the story that Dr. Umanos told of jogging one day with 3 others when a man with a pistol came up and shot at them. "He totally missed," Dr. Jones said, "The joggers threw rocks at him, and he ran away."

One story did not end as well. During his stints in Kabul, Dr. Umanos lived in a Cure International compound that once included a dentist, said Dr. Jones. The dentist drove to a community just north of the city to conduct a clinic, and on his return trip, he was shot and killed.

Married and with 3 children, Dr. Umanos sometimes expressed concern about the threat of violence, but he nevertheless remained committed to treating children in Kabul, said Dr. Jones. "Jerry just felt like he was in a place where he was supposed to be, even though there was danger."

The Taliban has doggedly tried to topple the government of Hamid Karzai and regain power since its defeat by the US military in 2001. One of its tactics has been to infiltrate the Afghan army and police and then gun down unsuspecting US troops. The fatal shooting of Dr. Umanos on April 24 appeared to follow that pattern, except that the target was not a soldier, but a civilian.

A female obstetrician-gynecologist at Cure International told a newspaper called the Daily Outlook Afghanistan that she suspected the gunman had foreign connections.

"No Afghan who sees women, children, and the disabled walking in and out of these doors could ever do such a thing on their own," the newspaper quoted her as saying. "Only someone who wants the worst for Afghanistan, for us to continue to be sick and broken, would do something like that."

The police officer who fatally shot Dr. Umanos and the 2 other Americans (who were not physicians) with a Kalashnikov rifle then shot himself but survived, in large part because clinicians at Cure International took him inside and treated his wounds.

Dr. Umanos' wife, who spent long stretches in Afghanistan alongside her husband teaching children, expressed the same kind of benevolence when she spoke to television reporters after his death.

"We don't hold any ill will toward the Afghan people in general, or even the gunman who did this," she said haltingly. "We don't know what his history is.

"Jerry had a love and commitment that he expressed to the Afghan people because of (the) love of Christ. He saw the need, he went as I did for several years, and that need continues.

"We would really like for all of our friends and family and everyone else to honor Jerry's memory by opening up your heart to the Afghan people."

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