Doctor Everywhere

Pediatrician and 2005 Haverford Award recipient Joel Selanikio ’86 has investigated outbreaks in Haiti, treated tsunami victims in Indonesia, improved public health technology in Africa, and served as an advisor to government officials on bio-terrorism in Washington.


When Dr. Joel Selanikio ’86 worked for an Army hospital in Hawaii a few years ago, he met a Navy officer in one of his advanced life support courses. The man was the chief medical officer for the U.S. Pacific Command based in Hawaii, and, like Selanikio, a pediatrician. As it turned out, he’d trained in the same program as Selanikio, at Emory University in Atlanta. Selanikio asked him how he’d managed to transform from an Atlanta kids’ doctor to a naval surgeon and admiral. The reply was unexpected.
“I’d like to tell you that it was through some clear course that I plotted out, but that would be a lie,” the officer responded. “It was a series of completely random events.”
Selanikio—who received the 2005 Alumni Association’s Haverford Award—could have used the same explanation to describe his own circuitous path. Over the last 20 years, he’s gone from majoring in sociology at a small liberal arts college; to working on Wall Street; to investigating international outbreaks of virulent maladies for the Centers for Disease Control (CDC); to developing software; to practicing and teaching medicine in Washington, D.C.; to advising then- Secretary for Health and Human Services Tommy Thompson during the post-9/11 anthrax crisis; to treating victims of last winter’s tsunami in Indonesia. Selanikio’s life has been far from “planned.” Even his selection of Haverford was accidental
“I grew up in a working-class town in Long Island,” he says. “My parents had not gone to college, and my high school wasn’t shooting most of its students toward schools like [this]. It was more: ‘Which state school do you think you want to attend?’” Haverford only made Selanikio’s list because a friend of his father’s, and that friend’s son, were alumni.
“Like so many things,” he says, “random.”
A career in medicine was barely a seed of an idea as Selanikio pursued a sociology degree at Bryn Mawr (while enrolled at Haverford), and took classes in computer science as well. “I started taking chemistry at Haverford,” he says. “I don’t remember doing very well —and it was the last hard science class I took here.” His time at Haverford also led him to become convinced as a Quaker in his early 20s. He knew nothing about Quakerism (“I was probably confusing Quakers and Amish”), and began attending meetings as a student. “I’m definitely a non-programmed type of Quaker,” he laughs, “the silent meeting type.”
After graduation, Selanikio’s computer science background helped him procure a job with the then-Chase Manhattan Bank on Wall Street. “I liked the job and my co-workers,” he says, “but I didn’t want to spend the rest of my life working just to make the bank more money.” Medical school, a concept he’d first entertained in his early years at Haverford, became a tangible opportunity. He completed a post-baccalaureate program at Bryn Mawr, and was accepted early decision at Brown University School of Medicine. He graduated in 1992.
He moved to Atlanta for a three-year pediatric residency at Emory University Hospital, and met several infectious disease specialists with ties to the nearby CDC. They recommended Selanikio for a two-year fellowship with the Epidemic Intelligence Service (EIS), an apprenticeship in public health and epidemiology that sends participants on international outbreak investigations. It wasn’t long before the new doctor was on a plane to Haiti to explore the unexplained death of 100 children in the capital city of Port-au-Prince.
The situation in Haiti was cinematic: “It was the outbreak investigation that everyone at CDC wanted to be part of,” says Selanikio. Over the course of six months, children were being admitted to Port-au-Prince’s university hospital with a variety of symptoms and ailments, and all would die of renal failure. CDC specialists didn’t see any signs of infectious disease, and wondered if the cause lay in some sort of exposure or contamination. Thus, Selanikio, who was working at the National Center for Environmental Health, was sent as an environmental investigator. Using a case control study, he and other investigators examined factors attributed to both children who had died, and those who had survived. It quickly became evident that those who’d died were overwhelmingly likely to have taken one of two different anti-fever medicines that were locally manufactured.
“This was not a dry investigation,” Selanikio recalls. “It involved tear gas in the streets and riots and lying pharmaceutical companies and dirt poverty and no quality control in the factories and this Byzantine network of families who control everything [in Haiti].” But the story did have what he calls a “partially happy” ending: The CDC investigators deduced the cause (impure medicine) and stopped the deaths, and the FDA began providing more expertise and quality control for pharmaceuticals, making reoccurrence less likely.
As Selanikio traveled to various trouble spots with the EIS, he began questioning the methods used to collect data during outbreak investigations. He was particularly concerned about the minimal usage of information technology. “If you walked into your bank and saw people working on clay tablets, or without calculators, or with scratch pads, you would think something was bizarrely wrong,” he says. “In exactly the same way, I noticed that all the data collected for different health studies in developing countries was put on paper, and I thought, ‘They have hand-held computers. Why don’t they use them?’”
With this in mind, he teamed up with computer scientist Rose Donna to start DataDyne, a Washington, D.C.-based company that develops user-friendly software for hand-held computers, survey forms, reference texts, and calculation programs, and also consults on public health and data collection, with the goal of advancing the efficiency of epidemiological investigations in underdeveloped countries. Donna, who met Selanikio through the Red Cross, remembers how his infectious energy and enthusiasm for the venture convinced her to sign on. “He’s a nerd,” she says affectionately, “with a great sense of humor and a willingness to try anything. He takes everything we do to a higher level.”
Although Selanikio and some of his colleagues have employed handheld computers for several years, he recognizes the reason why non-profits and NGOs in countries like Zambia or Zimbabwe have yet to take advantage of the technology: “You have to have somebody to program them, or you have to hire somebody for tens of thousands of dollars to do that.” The problem lay not with the hardware, he realized, but with the cost of both software and programming consultants, as well as the hassle of locating and hiring those consultants. Through DataDyne, Selanikio and Donna sought funding for a software program that, he explains, “would take the 80 percent of people who just want to do very simple stuff and allow them to do it themselves in a frictionless, word-processor-easy way. If you have a series of questions and you know the responses to possible multiple choice options, you ought to be able to just type them in and hit a button and it goes into a handheld computer.” That grant-funded software program is called EpiSurveyor, and its beta version is now being tested with a CDC and WHO (World Health Organization) group in Kenya. In the next couple of months, DataDyne will release EpiSurveyor.
“When I talk about this, people say I seem very passionate about it; well, I am,” says Selanikio. “I’m not sure how many great ideas we get in our lifetime, but I think this is one. I’ve seen how it works, I know it’s going to make a huge difference, and I’m happy to be part of it.”
In September, 2001, Selanikio was still a CDC employee, living in Hawaii, working with the Navy on refugee health issues. On September 11, he was in Geneva, Switzerland for a WHO conference, and heard about the first plane hitting the World Trade Center from a friend. “We made this mad dash through the building trying to find a television, and we found one in the WHO publicity office,” he says. “There seemed to have been exactly one television in this entire huge building.” They turned it on in time to see the second plane’s impact, and Selanikio spent the next 24 hours in his hotel room, watching CNN and frantically trying to reach his Manhattan-dwelling friends (all of whom were fine). He was unable to get back to Hawaii for another two weeks— the circulation of the anthrax-contaminated letters in D.C. intervened. A week later, the CDC sent him to Washington to act as senior advisor to Tommy Thompson.
“I’d heard that someone in Florida had come down with anthrax, and it was suggested he got this from outdoor exposure, or drinking water from a stream, which was not a strong probability,” says Selanikio. “People were saying that we hadn’t had a case of pulmonary anthrax in such a long time, and folks were always drinking from streams, so it just seemed unlikely. Besides, after September 11, everyone was just waiting for the next shoe to drop.” Selanikio, who was assigned to Thompson’s office based on his previous research in bio-defense issues (“It was in many ways related to my refugee expertise,” he says, “because both involved mass casualty planning”), lived in a hotel in D.C.’s Dupont Circle; he spent the next six weeks working seven days a week, 16 hours a day. “I didn’t see the neighborhood,” he says. “I just left before light every day and came home at 11 or 12 every night.”
As chief of operations for Thompson’s Emergency Command Center, Selanikio’s main responsibility was to organize and coordinate the flow of incoming data. “When I first arrived, there was no coherent case list,” he says. “In epidemiology and public health, this is part of the basics of outbreak investigation, having a current list that tells you who you think has something, who really has something, what’s the criteria for deciding, is there a particular test or combination of tests, is there circumstantial evidence?” Selanikio developed such a case list and compiled a daily report for the Secretary to keep him informed of events —such as new occurrences of anthrax or disproven cases.
One of the highlights of Selanikio’s job was his opportunity to work with D. A. Henderson, a giant in the field of public health, best known for heading up WHO’s program to eradicate smallpox, and for having directed the Center for Civilian Bio-Defense Studies at Johns Hopkins University. “I remember very clearly when I met him,” says Selanikio. “It was another incredibly hectic day in the command center, I was just leaving the room and someone introduced us. I said, ‘Oh, it’s nice to meet you, sir,’ and I was preparing to breeze past when I stopped and said, ‘You’re D.A. Henderson?! Sir, it’s an honor to meet you.’” He remembers thinking, at the time, that he had never before said those words to anyone. “Working with him was quite an experience, because from his perspective, here I was this kind of know-nothing whippersnapper, so every time I felt strong enough to disagree with him about something, it was like swatting flies.” Selanikio would later become the first chairman of the National Smallpox Vaccination Taskforce, and co-author of the National Pre-Event Smallpox Vaccination Plan.
Selanikio’s time in Washington in the weeks following September 11 made him even more aware of a sobering reality: Despite the billions of dollars spent on national security, the United States is still ill-prepared to respond to a major terrorist attack, particularly a biological one. “In some ways we’re more prepared, in that we now have a smallpox vaccine for almost everyone in the country, and enough needles to administer it,” he says. “But who’s going to give the vaccine, and how fast can they give it if something happens?” One problem, he says, is that many are still skeptical of the idea that smallpox can be a threat. Though he believes the current war in Iraq, for example, has nothing to do with terrorism and is being used as a smokescreen, that doesn’t mean “there aren’t people trying to kill us. Many have concluded that the whole thing is made up, and that isn’t the case.” There are regimes throughout the world who have access to smallpox, left over from days when the virus was found in the wild; North Korea, he says, is a prime example. The risk lies not so much in the fear that these particular regimes will use it, but that others will get hold of it. “Suppose this were to happen and 20 people in different parts of the country [were infected], how fast could we respond?” Selanikio asks. “It’s not a question of ‘are we going to be able to save everybody’—the question is, ‘can we save at least most of us?’ At this point, we just do not have enough people trained, or enough of a coordination system to be able to respond to that, so we’re left hoping that nobody does it.”
When his job with HHS ended, Selanikio remained in Washington, becoming a staff physician and assistant professor at Georgetown University Hospital. He continued his work with DataDyne testing EpiSurveyor, and also co-founded Red Cell Associates, which aims to reduce the physical and technological risks posed by terrorism and other disasters through biological and security consulting.
In late December 2004, another shattering event spurred him into action. The day after a tsunami wreaked unimaginable devastation across Southeast Asia, Selanikio e-mailed Dr. Richard Brennan, the medical director of the International Rescue Committee (IRC), to offer his services. Only a couple of days later, he flew to Aceh, Indonesia as part of an IRC health assessment team to assist villages that had yet to be reached by humanitarian aid workers. The team arrived on New Year’s Day, 2005, and stayed for a month.
When Selanikio got his first glimpse of the city of Aceh, it didn’t seem to correspond to the chaotic images he’d seen on the news. Although a third of the city (the part closest to the water) had been destroyed, two-thirds of Aceh were nearly untouched, except by earthquakes. It wasn’t until Selanikio ventured down to the waterfront that he confronted the horror of what had occurred: The tsunami had left a tangle of timber, boats, trees, cars and people, and three to five feet of rubble that had to be bulldozed to make room for vehicles. Further down the coast, it was even worse: “Villages and towns of 10 or 20,000 people were wiped out. The only thing it reminded me of was pictures from Hiroshima; you’ve seen those photographs that are pieced together to form a panorama, and you look around and see where the streets and buildings were? Here, you could see where the steps had been to the house, you could see the tiled floor from the kitchen or the bathroom, you could see where the plumbing went into the ground. But most of the rubble was gone. There would be one building still standing in a town of 10,000 people. Of the eight or 10,000 inhabitants, there were maybe 20,000 left.
“It was beyond anything I’d ever seen before.”
The IRC team set up a clinic in the village of Paya Sumatok, in an outbuilding for a mosque that had a concrete floor. By now, a week had passed since the tsunami hit, and citizens with the most serious injuries had either left or died. However, Selanikio and his colleagues still treated scores of patients with horrific lacerations and broken bones, and were able to evacuate some who otherwise wouldn’t have survived. Selanikio found that most people were more psychologically functional than one would expect, not suffering from the kind of shock typical after surviving such a tragedy. “I suspect that if, heaven forbid, something horrible happened to you, or to your house, but everything else was intact, you’d be safe to collapse, lose control, fall apart, because you’re surrounded by people who are taking care of you,” he says. “In a situation where everybody is affected by the same thing, and nobody’s there to help you, somehow you sense that you don’t have the liberty of collapsing. The people I met were very active in either trying to figure out how to rebuild their homes, or find their loved ones, or trying to get medical care for folks.” The team treated one woman, nine months pregnant with a broken back, who had been lying on her back waiting for help for 12 days. Friends and neighbors had been bringing her food and sheltering her from the sun. (She was evacuated, and her baby was delivered safely.)
Incidentally, Selanikio celebrated his 41st birthday in Indonesia, on January 13. “That was the day we were taking a boat to go to one place or another and we got to go for a swim,” he says. “Physically, the environment looked just like Hawaii—beautiful water, gorgeous mountains—and it was the first time I’d gone swimming since I’d been there. It was fantastic.”
His birthday swim was one of the few moments of recreation he or any member of the IRC team enjoyed during that hard month, but they toiled without complaint—almost. “Sleeping on the concrete floor (of the clinic) was probably the only thing any of us complained about, even in a lighthearted way,” says Selanikio. “There were bugs all over the place, it was hot as hell, but you wouldn’t hear a word out of the IRC folks. They were all really good, hardworking people.”
Dr. Richard Brennan returns the compliment: “I was impressed by Joel’s energy, and his willingness to do anything; go down the street to pick up medicine, attend a meeting, he was really a team player. Nothing went 100 percent for us over there —nothing ever does in an emergency situation—but Joel was constructive in his criticism and his recommendations for how to improve the situation. He’s a great thinker and contributed significantly to the development of our strategy.”
“It was really rewarding to do that work after the tsunami,” says Selanikio, who returned to Aceh in August for more clinical work. “I’d like to take three weeks to a month every year and volunteer with (IRC).”
He has a house and an office in D.C., but Selanikio still spends many weeks overseas, primarily involved with projects for DataDyne. He continues teaching and treating patients at Georgetown and acts as a technical consultant with the American Red Cross for its measles immunization program. Inspired by his service in Aceh, he’s also been taking Indonesian lessons.
In the spring of 2005, Selanikio’s name was presented to members of the Alumni Awards Committee as they convened to consider the year’s nominees. “Alums who are nominated are impressive individuals,” says Awards Chair Melissa Allen ’86. “They have made a significant impact professionally, socially, or personally.” The Haverford Award—which, as its official description states, “supports and demonstrates the College’s expressed concern for the application of knowledge to socially useful ends”—honors a candidate who has proven to be extraordinary across the board. “For myself, Haverford Award recipients not only enlighten and inspire me as to the many diverse uses to which a degree can be applied, but they remind me of all of the best qualities that a ‘Haverfordian’ should embody,” says Allen.
Selanikio was the Committee’s unanimous choice. “Reports of his service in his various positions repeatedly recounted his tireless efforts to ‘improve the system,’ his willingness to serve 20-hour days for months on end, and his passion to apply his knowledge in diverse aspects of his field,” says Allen. “He is also extremely young to have accomplished so much.”
The doctor was honored by the award, but humble in accepting it. “It puts me in mind of the many, many people I’ve met since my years at Haverford who have spent far more time than I in working for social justice, civil rights, access to healthcare, and many other things,” he says. “Next to these other people, I feel that my accomplishments are modest.
“I look to them, and to the Quaker ideals that I first encountered at Haverford, for inspiration.”