When I ask Francesca Gany, MD, how she came to be a pioneer in the field of immigrant health—a new branch of medicine devoted to making the health care system responsive to the foreign-born—she answers with a story: The Mystery of the Stomachaches of the Senegalese Street Vendors. Gany was a resident at Bellevue Hospital Center in 1986 when she met a patient from Senegal who had an advanced case of Hansen's disease, formerly called leprosy. "He agreed to be admitted to the hospital but refused medication," says Gany, now 41. "He was a really nice, cooperative person so I knew there had to be some good reason, but since no one spoke his language, Wolof, he couldn't say what it was. Fortunately, we both spoke some French. I learned he'd contacted his family back home, and they'd consulted a healer who told them that the spirits were angry because he'd left his country and family behind and that he wasn't going to get better until he had a traditional healing ceremony. I called the healer in Senegal and said, 'I want to work with you. How can we help him?'"
The healer told Gany that their patient needed to come home for the ceremony. Gany explained that he was too sick to travel and asked if there was some way the ritual could be done in New York. The healer agreed to do it over the telephone.
"As soon as the ceremony was performed, the patient began taking his medicine and he got better," Gany says. "He was so pleased with his treatment that he started referring his countrymen to Bellevue." Because of a drought at home, many Senegalese men had come to New York in the late 1980s seeking work to support their families. They put in long hours peddling watches on the street and lived in cheap hotels, sometimes ten to a room.
"In came these men, one after the other, with the same set of symptoms: severe, persistent abdominal pain radiating around their waists," says Gany. All the tests came back negative. With the aid of an interpreter, she began interviewing the men using guidelines created by a medical anthropologist to help doctors understand how patients explain their disease: What do you call your illness? What do you think is causing it? Why do you think it started when it did?
What a remarkable woman, I thought, as Gany disclosed one amazing accomplishment after another—all the more so for not presenting herself as such. "I'm actually very shy," she tells me. "I don't like to upset the applecart. I always had my own beliefs as a kid, but I was quiet about them. I respected authority. I went along the regular course.... But once I came to Bellevue, I knew that this was what I had to do. I had never worked in a city hospital, and it was a jolt. I had a typical suburban childhood and really wasn't aware of the inequities in the world. But it became so instantly clear to me that such a big segment of the population was being cared for with so much less. It was really, you know," Gany pauses, waiting for the right word to come to mind, "disgusting," she says finally. "I decided that I was going to give those with whom I came in contact the best medical care possible. I think it's really true," she adds, "that if people try to make their own sphere equitable and good for people, if everybody did that, it would work."