“Go and do thou likewise,” proclaims the Cornell University-New York Hospital School of Nursing alumni pin.
Mary Skarie BSN ’73 seems to hold true to this edict, helping others daily in her work with the Central Asia branch of the U.S. Agency for International Development (USAID), a federal organization that helps countries in need. Specifically, Skarie manages programs that strengthen primary health care and restructure health care systems in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan.
Skarie’s interest in international work began in childhood. Already influenced by her father’s international interests, Skarie met a visitor from India when she was five. She knew then that she wanted to live and travel abroad. In addition to her fondness for other countries, Skarie also emphasized her interest in altruism, making international health care a logical career choice.
“It’s always wanting to help,” she said. “I saw health as a way that would be always useful.”
Skarie became particularly interested in public health after studying abroad as an undergraduate at Antioch College in India. Just beginning was the family planning movement, a subject that sparked her interest.
After obtaining a bachelor’s degree in philosophy, she attended nursing school at Cornell through the Weill Medical College, where she became a registered nurse.
The nursing program at Cornell ended in 1979 for financial reasons. According to Pam Bennett-Santoro ’77, the president of the Cornell University-New York Hospital School of Nurses Alumni Association Inc., funding for nursing education and the social security money used to pay for many school-provided services simply ran out. The hospital and university decided that they could not replace the lost money and ended the program.
Currently, the alumni mailing list has 2000 people on it, with about 100 of them working internationally.
“Our alumni association is filled with many women and men that are distinguished and doing good works,” Bennett-Santoro said.
Skarie said that she both enjoyed and learned a great deal from her time spent at Cornell. She participated in the nursing program that allowed a student with a previous degree to become a registered nurse in two years.
“What I really loved was the opportunity to work in New York City,” she said. Working on health care in the South Bronx led her to realize her “true love” for public health. She was also influenced by the number of students at Cornell interested in connections between health care and human rights.
“Health care is not something you can see in a vacuum,” Skarie said. “You have to consider the ethical background.” Currently, Skarie is applying the principles she learned at Cornell and at Johns Hopkins to the sector of public health in Central Asia. Although she did not even know the locations of Kazakhstan and Turkmenistan when applying for the job, she is now proud of the work she does in those impoverished countries.
“It’s been the opportunity to work on programs that actually make a difference for many, many people … in some cases, entire populations,” she said. In Kyrgyzstan, the program she runs affects nearly the entire population of five million people.
In particular, she appreciates the fact that USAID focuses on development and rebuilding, rather than just humanitarian care. The program she manages concentrates on helping countries to make changes in how they structure their health care systems.
“It’s not just coming in and providing a Band-Aid. It’s trying to change the situation so that in the future this will be better,” she said. “We want to have a long-lasting effect, not just a temporary effect.”
Especially important for these countries is the restructuring of their health care systems, which have been in shambles since their independence from the USSR. Skarie explained that the USSR left behind a developed but inefficient health care system. Instead of having a general hospital, a town would have a hospital with many separate units and wards, each requiring separate administration and laboratories.
According to the USAID report on Central Asia, this system pressed people’s resources at even the best times, and often people had to travel to multiple facilities to receive adequate care.
Although it fulfilled the USSR’s goal of creating jobs, this system was far too expensive for the newly independent countries to run.
“There were a lot of problems with how the system had evolved and [it was] very outdated,” Skarie said.
The health among the population in these countries reflected the system’s inadequacy. According to a USAID report from 2000, both infant mortality and cases of tuberculosis increased after the countries became independent.
The USAID approach differs from the old system by establishing general hospitals, training doctors in more general subjects instead of strict specialization and allowing patients to choose where they can obtain medical care.
Along with the general problems of attempting to restructure entire health care systems, Skarie has also had to deal with political instability in some of the countries.
In Turkmenistan, where she runs the Keeping Children Healthy program, the government strongly opposes any type of organization focused on an issue. However, Skarie says that the government has found it more acceptable to organize around health care than other issues, and even asked USAID to expand the program.
“It seems it’s not terribly threatening for the government to work on mother and child issues,” she said.
Although her work in Turkmenistan is difficult, Skarie said she found her work in Tajikistan particularly frustrating. Having toured the country after a civil war and three-year drought, she said that she was very affected by how dire conditions had become.
“Really, the needs were quite overwhelming,” she said. “I was particularly struck by the children that were malnourished and the women who were suffering.”
Despite the appalling situation at the time, she feels that her work and USAID truly were able to make a difference in the country.
“What is gratifying is that we were able to put a program in place and [that] we’ll soon see some excellent results,” she said.
For those interested in doing this type of work, Skarie recommends that they “get a real skill first.” She advises obtaining a degree in nursing, medicine, health education, social work or health economics before acquiring a public health degree.
Archived article by Shannon Brescher