Earlier in March, Bishop John had the pleasure of being a guest of the Edinburgh Jewish Cultural Centre and the Royal College of Surgeons of Edinburgh at the biennial Herzfeld Prize award ceremony. The Herzfeld Prize is awarded in honour of the memory and achievements of Dr. Gertrude Herzfeld (1890-1981), a pioneering surgeon who was the second female fellow and the first female practising fellow of the College. Dr. Herzfeld was one of the first female surgeons to work in Scotland and was a pioneering Jewish female paediatric surgeon in Edinburgh. The Herzfeld Prize is presented every two years to a living outstanding Jewish woman, from any country, who has excelled in surgery, medicine or public health, or the sciences as related to these fields and whose life and career emulates the lifetime values, hard work and success of Dr. Gertrude Herzfeld. This woman should emulate the leadership, audaciousness, commitment, and drive that Dr. Gertrude Herzfeld conveyed.
This year’s prize was awarded to Dr. Mardge Cohen, a prominent figure in HIV advocacy and women’s health for over 45 years who serves as the Medical Director of Women Equity in AIDS Care and Treatment Rwanda (WE-ACT×) and practises at Boston Health Care for the Homeless. The award was presented by the official representative of the Royal College of Surgeons of Edinburgh, Kirsty Mozolowski; the Head of the College of Medicine and Veterinary Sciences at the University of Edinburgh, Professor David Argyle; Chair of EJCC, Janet Mundy; the Lord Provost of the City of Edinburgh, the Right Honourable Robert Aldridge, and his Consort, Dr. Colin Cunningham; and Chair of the Herzfeld Prize 2024, Hannah Handelman. We’re very grateful to be able to share Mardge’s acceptance speech below.
”Thank you so very, very much to the Edinburgh Jewish Cultural Centre and The Royal College of Surgeons of Edinburgh for this truly special award and all of you for being here this afternoon. I am humbled by the life and inspiration of Dr. Gertrude Herzfeld and by your honouring me with this award.
Dr. Herzfeld graduated medical school in 1914, was a pioneer in paediatric surgery, and was the first practicing women surgeon to become a Fellow of the Royal College of Surgeons of Edinburgh. She understood children were more than little adults, recorded her results and new surgical approaches, and tackled difficult medical issues like deciding on surgery for children with ambiguous genitalia, an issue most doctors shied away from. Her obituary in the British Medical Journal documents that as patients all over Scotland came to her for gender defining surgery she used “infinite thought, getting to know the child, the mother, the surroundings… [reflecting her] warmth and wisdom combined with her skill.” She was committed to the health of women and children in ways that were ahead of her time. She led the Edinburgh branch of the British Medical Association, was National President of the Medical Women’s Federation, and chaired the Soroptimists, always advocating for women. She died in 1981 the year HIV illness was first reported.
When I started medical school in 1972, my medical school class was only 20% women, and that was twice the U.S. average for women entering medical school. But the 1960s and 70s was the start of a sea change in women’s lives in general and the number and kind of doctors women became. Calling women “Ms.” became acceptable; the age at first marriage rose, women made choices to not marry or keep their own names; and the number of advanced academic degrees received by women increased. Abortion became legal in the U.S. and Scotland, among other places, women gynecology residents increased from 16% to over 85% currently, and for the fifth year in a row, women now make up more than 50% of U.S. and Scottish medical students.
I grew up in New York City in a home with Jewish parents. My grandparents had immigrated to the U.S. in the early 1910s. My brother and I were inculcated with the Jewish values of caring about family; caring about others who were less fortunate; fighting against inequities; making the world better, and, if you could, becoming a doctor. And we did. We were also products of the sixties, particularly the anti-war, civil rights and women’s movements. I have always felt the lessons I learned during those years reflected and reinforced those special Jewish values. The optimism, the commitment to listen to and learn from the people most affected by society’s inequities; siding with the underdog; the idea that the personal is political, and the importance of working together for collective responses to injustices are lessons that have guided me over the last 50 years.
Women are taught to be empathetic and caring and to listen. Yet these behaviours and values, I’m sure you would agree, are in contrast to the arrogance that sometimes comes with advanced degrees and professionalism—the learned sense that we know more than our patients and everyone else. As a doctor, I have learned over and over again that listening and partnering with those most in need teaches us respect and how to work together as a real team.
I practiced general internal medicine at Cook County Hospital, a large public under-resourced hospital in Chicago, for 31 years. In 1987, a patient named Ida Greathouse knocked loudly on my clinic door. She was going to the HIV Clinic, which had been started 4 years before by nurse and physician colleagues in response to the AIDS crisis. Ida accused me of not caring enough about women’s health, citing proof that if I did, I would start a dedicated clinic to meet the special needs of the growing number of women with HIV and their children. She screamed that women’s unique needs were not being met in the clinic serving mainly gay men and men who had injected drugs. This was early in the epidemic, a time when women accounted for only 7% of persons with AIDS in the U.S.
I took Ida’s admonitions to heart (she was impossible to ignore) and, with a group of women health workers, we started the Cook County Hospital Women and Children’s HIV Program. To deliver the services that Ida Greathouse challenged us to provide, we assembled an incredible multidisciplinary team: internists, infectious disease specialists, obstetrician gynecologists, paediatricians, family practitioners, nurse practitioners, nurses, psychologists, health educators, case managers, social workers, chemical dependency counsellors, domestic violence counsellors, pastoral care workers, virologists, immunologists, peer educators, lawyers and benefits advocates. We soon found ourselves caring for 2/3 of the women and children with HIV in the city of Chicago, more than 1500 patients. Lacking a precedent or special training for this new rising epidemic in women, we learned together. Together, with women and children and youth with HIV, we learned how to manage a new disease in a manner that respected the patients and health workers.
At first it seemed the only thing we could do was cry together (we had monthly memorial gatherings), as hundreds of women died because of lack of effective medication and because of violence and drugs; we celebrated when we finally had effective therapy to extend lives. We were in awe of the strength and resiliency of the women we were caring for. We saw women challenged by poverty, racism, and violence change their behaviours, and fight to stay alive, take their medications and reunite with their children to build strong families. By 1994, using the first antiretrovirals we reduced the rate of perinatal HIV transmission among infants born to HIV-infected women from 25% to close to 5%. Our team then developed the system to insure that all pregnant women were screened for HIV and tereated prior to delivery to reduced transmission rates to 0.
And that year because of this collaboration, our team at Cook County Hospital received the first National Institute of Health (NIH) grant to conduct research to better understand how HIV progresses in women and how HIV treatment (antiretroviral medications) would affect women. After 25 years, the Women’s Interagency HIV Study or WIHS, the longest supported cohort of women with HIV, joined with the MACS (the NIH study of men with HIV initiated in 1984) to continue studying how men and women age with HIV. This ongoing study now includes over 5000 men and women living with HIV as well as men and women without HIV from 14 U.S. cities. The study aims to better understand how HIV and its treatment affect heart and lung disease, malignancy, cognitive function and mental health in older people living with HIV. This transition from HIV being a fatal disease to people living with a chronic disease and having to cope with other medical diseases was an extraordinary turning point.
In 2004, ten years after the Rwandan genocide, ten years after one million Tutsis and moderate Hutus were murdered in just 3 months and a quarter of a million women were raped, many deliberately infected with HIV, women leaders of Rwandan associations put out an international call to help Rwandan women who were dying of AIDS. They wanted to fast track antiretroviral medications to these women, who had no access to medications. They told us that the men in jail, who had raped the women, were receiving medications for their HIV infection, while not a single one of the women they had raped, was receiving treatment, and those women were now sick and dying without the possibility of treatment.
Women’s Equity in Access to Care and Treatment (WE-ACTx) was born in response to this call. I went to Kigali with a small group of physicians and advocates to talk with the women from these associations and learn what we could do together. And over the last 20 years, we have worked with many Rwandan women’s associations and the public health system to build a comprehensive clinical program for 2500 people with HIV. Remarkably, over 90% of patients seen in the clinic this year are undetectable – meaning they are on antiretroviral medication and have achieved viral suppression and cannot transmit the HIV virus to others. The small number who are detectable face obstacles of chronic mental illness or alcohol or drug use. The programme is especially attentive to the psychosocial needs of women and youth. Women (and at times their partners) participate in support groups addressing intimate partner violence, helping their children cope with HIV, adherence obstacles, and the special needs of sex workers and young women. Children attend age-appropriate support groups to play together and, when able, to better understand how HIV affects them, and their potential to live a long and productive life. We are particularly proud of our practice and research in innovative approaches to increasing adherence to HIV medications among youth aged 14-21, so they too can have a future. These include addressing the impact of trauma and PTSD on Rwandan youth, encouraging self-esteem growth, employing older youth with HIV infection to model adherence and living full lives, and youth friendly support groups utilizing yoga and music. Providing school fees, job training, income generation projects and jobs when possible are also part of the clinic’s programme, which for many years has been fully staffed by Rwandans.
When I moved from Chicago to Boston in 2007, I was privileged to start working at Boston Health Care for the Homeless Program. For the last 16 years, I’ve cared for men and women who were living on the streets, in their cars, in shelters, or unstably housed if they were admitted to the medical respite unit when they developed acute medical problems or needed a reprieve from their very difficult lives on the street. These patients were as young as 20 and as old as 90. Most have experienced some form of trauma and might use drugs or alcohol or health care avoidance as coping strategies. Boston, like many cities in the U.S. which have homeless encampments, has recently closed down these temporary homes. Creating clean injection sites, providing high quality substance use and mental health treatment, building more low-income housing and decreasing income inequality are needed and proven to decrease homelessness. Most importantly, I have learned how important it is to acknowledge their existence and hear what people without housing are saying and want. And of course they have much to say and often of great worth about structural challenges and needed solutions.
Although the settings have varied, the idea of caring deeply and comprehensively has been part of the mission of my work in Chicago, Kigali and Boston. My husband, who has been my partner through medical school and our time as physicians, is quite sentimental about this subject and sometimes discusses how caring for patients means loving our patients – not sexually (we’ve left the 60s!) – but more in the manner Bell Hooks, the feminist author, defines Love. She writes “Love is a combination of care, commitment, knowledge, responsibility, respect and trust.” Arthur Kleinman the medical anthropologist, enlarges this to include those being taken care of in addition to the provider. Caregiving he says “is a practice of empathic imagination, responsibility, witnessing, and solidarity with those in great need. It is a moral practice that makes caregivers, and at times even the care-receivers, more present and thereby fully human.” Partnerships in caring and actively challenging inequitable systems and structures will bring us all to the best we can be.
Finally, I want to say that I think this is a very difficult time to be Jewish. People all over the world have been devastated by the horrific events of the current war in the middle east—the atrocities committed by Hamas in Israel and the massive ongoing retaliatory Israeli attacks on Gaza. Our hearts must be with all the people and communities facing violence. I’m sure each of you have your own thoughts about the news we are seeing every day. For me, the lessons from Dr. Herzfeld and my Jewish heritage and from caring for women with HIV in Chicago and Kigali and the homeless in Boston are to prioritize public health and human rights, to understand the context within which health and humanitarian crises develop and persist, and to speak out against injustice. We must stand together with the international community to end this public health disaster, where the lack of food and water within a decimated hospital and health care system brings more illness and deaths every day, especially among women and children. The World Health Organization warns that the soaring number of infections and other illnesses may ultimately kill more people than Israel’s bombs.
I think about my friends in Kigali who shared their experiences about living through the slaughter of so many Rwandans in 1994 and it does bring me some glimmer of hope. While things aren’t perfect in that country now, people who fought against each other and killed their neighbours are now living peacefully next door to each other. I was moved to read that the Scottish Parliament early on voted for support of a ceasefire in Gaza and release of all the hostages. Many of us in the U.S. are advocating and demonstrating for this as well.
Dr. Herzfeld’s family moved to Edinburgh from Vienna because of antisemitism. While many strides have been made in the 130+ years since her birth, we still need to seek further strength from her and others to fight oppression and build for health and peace everywhere. As we approach International Women’s Day this week, we should gain inspiration and strength from the 15,000 women who took to the streets in New York protesting for shorter hours, better pay and voting rights in 1908 and from women everywhere still fighting for inclusion, equality and peace today. Happy International Women’s Day! And thank you so much again.”