Susan J. Cole was born and raised in Illinois. She graduated from Wheaton College in Illinois and studied medicine at the University of Illinois College of Medicine in Chicago and Peoria. She completed an internal medicine residency at OSF Saint Francis Medical Center in Peoria, doing all her electives in pediatrics. She practiced in Pekin, Wheaton and now in Peoria. Cole spent five years in Angola, Africa as a medical missionary. While there she was the head of the pediatrics section of Kalukembe Mission Hospital, on the staff of the Pediatrics Hospital of Lubango and head of Pediatrics section of the Lubango Health Sciences Training program for Angolan physicians. Since returning to Peoria in 1992, Cole has been on the faculty of the University of Illinois College of Medicine at Peoria in the department of internal medicine. She’s been in private practice with Dr. Sara Rusch, a close friend and colleague since their days in training at OSF Saint Francis Medical Center. In October 1995, along with Kim Mitchell, RN CNP, Cole established the Women’s Health Screening Center at OSF Saint Francis Medical Center.In September 1997, Cole returned to full time private practice at the Mother Frances Krasse Family Center on Peoria’s south side.Cole’s married to, Dr. Paul Cole, a board certified specialist in internal medicine. They have four sons: Stephen (17), Ian (who passed away at age 2), Philip (12), and Peter (9). The Cole’s live in rural Metamora with an assorted menagerie that tends to follow families with boys: dogs, cats, birds, fish—plus a couple of cows to help with the mowing. Cole said she greatly appreciates living and working in Peoria “because of all the marvelous resources and people we have here in a city that still manages to feel like a small town.”“In all my travels I have never been in a place with such dedicated community members.”

What is the quality of medical education in Peoria?

Excellent. The University of Illinois College of Medicine at Peoria provides a top quality educational experience beginning in the second year of medical school with a foundation in the basic sciences of pathology, pharmacology, epidemiology and physiology.

Our students consistently receive the highest scores on national tests among all the medical schools in the state.

This is followed by two years of clinical training in Peoria area hospitals, where they taught by some of the most dedicated physicians I have known in my medical career.

They also see an impressive array of physical problems and diseases due to our position as the leading downstate referral center.

What do you believe are the important fundamentals for training health care professionals of the future?

As medical educators we must provide a strong foundation in medical knowledge and physical diagnostic skills, but we must also teach the importance of being good communicators with our patients and colleagues as well as being committed to patient advocates.

There are strong forces in the country today that profoundly affect the way health care will be provided in the future. Economic issues will direct decision making in health care delivery, and patients will need our help in deciding where to get the most for their money.

I truly believe we wont be able to pay for everything for everyone, and I would rather see each individual make the decision as to where their health care dollar is spent (with their physician’s help and support) rather than have all our health care decisions made by a committee determined to make a profit.

How have you balanced the demands of a family and a career?

I have been very blessed with a husband and family that have always supported me—they understand my profession is more than just a job, it’s a calling. I also have an excellent woman who helps out with homework and housework. I couldn’t manage without her.

Throughout my 17 years as a physician, wife and mother; however, I have to constantly keep track of my priorities. My family has always come first, and so there have been many times when I left medical practice completely, or when I have deliberately limited my practice to be more available for my family.

As women I think we need to realize and appreciate the truly unique role we play in our families—no matter how great we are in whatever field, no matter how awkward we may feel as homemakers—no one can ever take our place as wife and mother.

Under what mission organization did you serve?

We served with an organization called “Christian Missions in Many Lands” here in the states.

In Angola we worked with the Association of Evangelical Churches of Angola. Grace Presbyterian Church in Peoria was one of our strongest supporters.

What type of work did you perform in Angola?

A little bit of everything. Although I was trained here in medicine and pediatrics, in Angola I performed surgery, delivered babies (I’m particularly proud of the four C-sections), ran public health programs, taught nursing and medical students and village health workers.

I set up a regular clinic in a local orphanage and a regular follow-up program for children with sickle cell anemia and heart disease.

Along with my husband Paul, I also learned how to raise livestock, do my own butchering, raise peanuts, pasteurize milk and make cheese. (Some of this I learned how to do from the “Little House on the Prairie” books, but I was amazed at what all you can find in “Joy of Cooking.”)

What are the most striking differences in basic medical care afforded to the people of Angola as compared to the U.S.?

Without a doubt, the most striking difference is the incredible poverty of the Angolan people when compared with the U.S. in almost every area of life—medical care most of all.

There are almost 10 million people in Angola; there are less than 300 doctors in the entire country. In Peoria alone there are more than 800 doctors. Angola has more land mines than any other country in the world—estimates suggest there are two mines for every man, woman and child.

Almost 5 percent of the total population are amputees. One out of every two children born in Angola dies before the age of five. The average life expectancy is 45.

I worked mainly in pediatrics the five years we were there. I have seen whole neighborhoods of children wiped out because of measles—a preventable disease. I have watched children die from rabies, malaria, diphtheria, cholera, tetanus and polio.

Most of the medical students I train here have never seen—never will se, I hope—any of these things.

In the entire time I practiced in this country I have only had one child die in my care.

At the Kalukembe Hospital I watched an average of five children die every week. I was in despair over this—then I went to work for the government hospital in the city and discovered that they were losing eight children every day. This was a city the size of Peoria. The premier pediatric hospital in Angola averages 1,200 deaths per month in their emergency room.

What was the experience like for your family? What challenges did you face raising young children from a different culture?

Awhile back we asked our children when they were the happiest in their lives—Paul and I were surprised when they all agreed that they were happiest in Angola.

There was no doubt it was very difficult for them—they all missed their grandparents and other relatives very much. It was not easy for them to always be “different”—their blue eyes and blond hair would always attract a lot of attention wherever we went.

Angolan children wanted to touch their skin and hair; they wanted to know if they were white all over.

The boys had to learn to communicate in Portuguese (although our middle son, Philip, always his own person, insisted teaching his friends to speak English—their parents were delighted.)

On the other hand, Angolan culture was slower paced and more accepting. The country itself is very beautiful and we made the most of all our opportunities to see as much of it as we could.

Seeing elephants and giraffes in the wild is a wonderful experience for children. I enjoyed it too. It’s amazing how much time in the day is left over if you don’t have television. Most of your fun is community oriented—games, visiting, etc.

I think the most amazing thing about Angola is how thankful you are for the very little that you have, instead of being frustrated all the time about things you don’t have, like we are here. I have wondered if television is the source of this discontent as well as our lack of time.

How did your personal faith influence your work?

I don’t know how we could have survived without it. It not only gave us the motivation, the inclination and the energy, it also gave us the hope.

I don’t know how I could have survived all those days with children dying, how I could have risked my own children and husband in a country so full of diseases and war.

I believe it was the faith I shared that made the biggest difference to the people I served.

In my own puny efforts—300 doctors for 10 million people—anything else I could do was just a drop in the bucket.

But faith, well, that is what will finally make all the difference for Angola. Not money, or education or medicine—just faith.

What made you return to an academic setting?

We returned to Peoria in 1992 for several reasons. First, the political situation in Angola was rapidly deteriorating, and we were concerned for the safety of our children.

Indeed, six months after we left, government soldiers were marching into our hospital and dragging patients and staff out into the street and shooting them.

Second, we felt strongly that our children needed better educational opportunities and services.

We chose an academic setting because we felt out of sync with American medicine and we wanted to be somewhere where we could participate in continuing medical education.

I chose academic medicine because I felt it offered a more structured part-time pattern that allowed me to spend more time with my children as they got back into the swing of life in America.

What are the significant issues at the forefront of women’s health today?

I think the most significant issue facing every American today is how are we going to be able to continue to pay for health care.

Due to the break up of the family and the trends in business towards using more and more temporary help who don’t qualify for insurance benefits, we are going to see more and more single women raising families or growing older without access to health insurance.

In the area of medical research I think the most important issue in the next decade will be determining the exact role of hormone replacement therapy.

The Women’s Health Initiative and the National Nurses’ Study will finally give us the answers as to who should take hormone replacement, for how long, and what its relationship really is to the development of breast cancer.

Describe the development and purpose of the Women’s Health Screening Center.

The Women’s Health Screening Center has been operating since October 19, 1995. It was established with a grant from the Center for Disease Control and its purpose is to provide comprehensive health screening for low income women, 55 years and older.

Although the grant specifically targeted breast and cervical cancer screening, we sought additional funding for hypertension, diabetes, cholesterol and osteoporosis screening.

We try to help each individual woman determine what major health risks she is facing and help her prevent them and stay healthy. If we identify women who have a previously undiagnosed problem, we refer them to the Heartland Clinic or one of our university or hospital affiliated clinics where they can receive care at little or reduced cost. Our center is a collaboration between OSF Saint Francis Medical Center, the Peoria City/County Health Department, and the University Of Illinois College of Medicine.

How has the center benefited the women of central Illinois?

We have seen more than 1,500 women in the past three years. We detected and helped treat 15 breast cancers, eight cervical cancers, one endometrial cancer and one thyroid cancer.

Almost 50 percent of the women we see have high cholesterol and we have also diagnosed and sent for treatment, women with hypertension and diabetes. We try also to get women to follow more healthy lifestyles by encouraging exercise, weight loss, smoking cessation and seat belt use.

Of all these areas, we have had the most success in getting women to use seatbelts consistently.

What are your responsibilities as director of the Mother Frances Krasse Family Health Center?

The Mother Frances Krasse Family Health Center was developed to provide low cost, community based health care to the people of Peoria’s south side.

My responsibility is to provide that care.

Community based medical care means care that is specifically directed toward identifying the health problems facing a particular community, and creating new programs to treat and prevent them.

On Peoria’s south side that means being accessible and affordable to a large group of people who have not been able to afford that care previously.

It means getting good prenatal care to teenage moms as early in their pregnancy as we can; it means helping moms with children with ADHD and asthma get good coordinated health care; it means encouraging older minority women to come in for health screening; it means targeting obesity, diabetes and pulmonary diseases and providing patient support and education.

It especially mean coordinating support services, not just the medical ones, but educational, social and psychiatric, through cooperation with other community based organizations, like the health department, Neighborhood House, Catholic Social Services, and the Human Service Center.

What are your opinions on managed care and the U.S. health care system?

I think the U.S. health care system is the best in the world, without question. Managed care brings some very good things to health care in general and I would like to mention those things specifically:

• It puts a strong emphasis on keeping track of the quality of the medical care we receive.
• It teaches us the importance of disease prevention and early intervention.
• It forges new and stronger bonds between traditional medical care and public health.

However, it has also done some very detrimental things:

• It reduced medical care to statistics, formulas and numbers.
• It put impossible paperwork demands and production quotas on doctors and hospitals.
• It promoted adversarial relationships between primary providers and our specialist colleagues.
• It encouraged patients to switch primary care providers frequently due to economic pressures and disrupted doctor/patient relationships.

Lastly, and I believe, fatally, managed care has put the emphasis on healthy patients and vigorously resists paying for the sick ones.

They compete aggressively for healthy clients, and with each successful switch of insurance carriers, patients with chronic illness are left out. It is based on the faulty premise that there will always be enough healthy patients to carry the needy.

But no matter how good we get at preventing disease, everyone will become ill.

The only entity that, in the end, will be capable of carrying enough healthy people to even come close to providing for the needy will be the one that can enroll every single man, woman and child in this country.

That entity is the federal government. The inevitable result of managed care will be national health insurance.

What can be done in central Illinois to improve access to health care for the underserved in addition to free community clinics?

I think we need to creatively address the issue of low cost preventive care everyone can afford.

This would mean helping each family and individual to look at their resources and decide what they can spend on health care.

They would have to be educated as to what each individual service costs and shown where they can get the most for their money.

This would mean we would have to encourage preventive dentistry, childhood and adult immunizations, smoking cessation and regular exercise.

In Illinois we also need to give nurse practitioners more independence because they are the least expensive to train and the most effective in these areas.

I think that every person should realize how much medical care costs, and re-learn to value it.

Women especially need to appreciate this because we are the ones who determine what services our children and husbands and fathers receive. TPW