Armand Sprecher '85

We were in the time when most of the international agencies that were financing health care initiatives were convinced that local participation in bearing the cost of care was a good idea. We learned that when you do this, you essentially start excluding people from the health care system and you cause an increase in morbidity and mortality. For years we conducted studies to illustrate these perverse effects. Our programs were designed around showing local ministries of health that reasonable health care systems can be run without fees, and that their fear of moral hazard was unjustified.

It was a love of travel that paved the path to Armand Sprecher ’85 working internationally with Médecins Sans Frontières (MSF). “After Haverford, a handful of us got a Eurail Pass and bummed about Europe,” says Armand. “I remember Mr. Brownlow; he was in military intelligence during World War II and had a rather interesting career in Europe. His history course was a patchwork of personal anecdotes and lent some color to the Europe that we would later visit.”

Deeply interested in the sciences, Armand applied to medical school after completing undergraduate studies at Brown University. He took a year off to feed his travel bug, journeying to Australia, Spain, and Thailand. “When I returned to medical school, I pursued emergency medicine to permit me flexibility to travel and to allow me to be useful in any context,” says Armand.

As a third-year resident at the University of Missouri-Kansas City, Armand went to Bosnia and worked on an emergency medical project supervising and training Bosnian residents. Upon finishing his residency in 1997, Armand interviewed with MSF and was sent to Sri Lanka later that year. Since then, his career has taken him to Uganda in the midst of the 2000 Ebola outbreak, Burundi during civil war, Haiti with the Centers for Disease Control and Prevention (CDC) following the 2010 earthquake, and Brussels, an operational center of MSF. Along the way, Armand met his wife, a Belgian epidemiologist working in Uganda; earned a master’s degree in public health from Johns Hopkins University; and took a two-year leave of absence to work in New Orleans for the CDC’s Epidemic Intelligence Service.

Armand spent the first several years of his career struggling to adapt to the realities of international aid work. “There’s an assumption that being a medical person with a humanitarian medical relief agency means you’re going to go to another country, put gloves on, and make the sick whole and well,” says Armand. “Although this happens, more often you’re enabling local doctors and nurses to do that work. You expect your patient to be a person and your instrument to be a stethoscope. But now, as a program manager, your patient is a population of people, and your instrument is a medical service that you have to manage.”

Armand is a noted expert on Ebola, which for years was a small job but has become more significant in light of the 2014 outbreak in West Africa. “Ebola used to be, probably still is, a fairly rare disease,” says Armand. “Up until the beginning of 2014, there were fewer than 3,000 cases that we knew of over 40-plus years. When I got started in Gulu, Uganda, there were 425 cases and that was the biggest outbreak in history. I was deeply involved in all aspects of Ebola, including clinical care, development of therapy guidelines, protective equipment and infection control, outbreak management, the anthropology and epidemiology of it … it was a small subject in which you could be well-versed. In early 2015 we saw a situation of a completely different magnitude at more than 50 times the worst outbreak on record.”

Gaining the trust of the local population is paramount in providing effective care and was particularly crucial in the quest to contain Ebola. Anthropologists accompanied MSF doctors, including Armand, into the field to help navigate cultural differences and potential misunderstandings. “In the beginning when we were trying to set up the outbreak control apparatus in southern Guinea, plenty of people were glad we were there,” says Armand. “But, a minority were filled with conspiracy theories – that these strange white people had come to spread the disease, that we planned to collect their blood to sell it to pharmaceutical agencies, or that we were going to kill them and harvest their organs to sell on the black market. Periodically, people would throw stones at us. This makes outbreak control very difficult; it can’t be done without the buy-in of the population. You take care of people and produce survivors, who ideally go back to their community and bear witness to what you’re doing. Unfortunately, these people are typically immediately ostracized and seen as a threat to community.”

In the beginning when we were trying to set up the outbreak control apparatus in southern Guinea, plenty of people were glad we were there. But, a minority were filled with conspiracy theories – that these strange white people had come to spread the disease, that we planned to collect their blood to sell it to pharmaceutical agencies, or that we were going to kill them and harvest their organs to sell on the black market. Periodically, people would throw stones at us. This makes outbreak control very difficult; it can’t be done without the buy-in of the population.

Armand has also dedicated a portion of his career to addressing the topic of health care inequity, the root cause of which he believes is poverty. When he first started at MSF, the crusade was access to care. “We were in the time when most of the international agencies that were financing health care initiatives were convinced that local participation in bearing the cost of care was a good idea,” says Armand. “We learned that when you do this, you essentially start excluding people from the health care system and you cause an increase in morbidity and mortality. For years we conducted studies to illustrate these perverse effects. Our programs were designed around showing local ministries of health that reasonable health care systems can be run without fees, and that their fear of moral hazard was unjustified.”

Technological advances – data collection and organization in particular – can help increase the quality and availability of care worldwide, believes Armand. For the past seven years, he has been working with colleagues to develop a standardized coding system for electronic representation of medical concepts. “There needs to be a lingua franca of medical data run not just by different MSF offices, but by different NGOs or organizations such as UNHCR,” explains Armand. “If I want to tell somebody on the other side of the world that in Burundi in 2012 we saw 50,000 patients with malaria under the age of 5 in a specific hospital, I have to spell that out. There’s no way to reduce that to a small sequence of codes that would allow automated systems to talk to each other. When you’re an international organization, there are numerous languages, workers can write to a spreadsheet in whatever format they want, and someone has to collect all of those reports and make them fit together. That makes operational intelligence for a multinational organization like MSF very difficult.

“There are three questions you have to ask yourself when you run a health care project: Am I doing enough? Am I doing a good job? Should I be doing something else? The operational data system is designed around answering those three questions. The assumption is that you know how many patients you should be treating so you can compare that number with your target. If you didn’t treat enough patients, what do you need to do to serve more people? Are you hitting quality benchmarks? Do we have a good epidemiologic surveillance system so we can look at the patterns of occurrence of diseases and say, ‘Is something going on that we are unprepared to deal with?’ Is there an outbreak of cholera or a rise in seasonal malaria such that I have to change the way my operations are delivered? These are basic management questions that we can do a better job of handling with the right system in place.”

Through all of Armand’s travels, it is the similarities – not the differences – that he recalls most. “The thing that always struck me was however different people may appear initially, the more time you spend with them, the more ordinary they seem,” says Armand. “Wherever you go, people are people.”

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