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Fighting for women's health

Dr. Steven Kleeman, MD '94, is director of urogynecology at Good Samaritan Hospital in Cincinnati, but he's been making a habit of traveling worldwide on medical missions to assist women in developing countries.

by Elizabeth DePompei

Before his first time in an operating room, a nervous 18-year-old Steven Kleeman hit the vending machines. He was aware of how often first-timer scrub techs got sick during labor and delivery, but fear took over his senses. Two sandwiches later, he was witnessing a cesarean section and the wonder of birth.

“I tried not to like it,” Kleeman confesses.

But he couldn’t deny the rush that he felt after that first day in the O.R. — a feeling he remembers vividly: “You see someone pregnant, but you don’t see the baby, and all of the sudden there’s this baby."

Kleeman’s mother was a labor and delivery nurse at Good Samaritan Hospital and encouraged her recent high school graduate to try working at the hospital alongside her, setting up the operating room and assisting the staff during delivery — which he continued to do all the way through his undergrad years at Wright State University.

Despite his initial reluctance to put in the long hours often required in women’s health and delivery, Kleeman liked it too much to do anything else.

“It’s one of those rare fields where you get to see someone through the many different stages of their life,” Kleeman says. “You get to participate in very intimate parts of their life."

After earning a medical degree from the University of Cincinnati’s College of Medicine in 1994, Kleeman returned to Good Sam to complete his residency in the hospital’s department of obstetrics and gynecology. His career on the operating theater stage was set.

After residency, Kleeman had the opportunity to further subspecialize in a field that, even now, is considered new in the medical world -- urogynecology. The subspecialty of urology and gynecology treats women’s pelvic-floor disorders like urinary incontinence and prolapse. It is estimated that one in three women will be affected by a pelvic floor disorder in her lifetime.

Although 33 percent of women are affected, the field lacks research and funding, says Kleeman, now director of Good Sam’s urogynecology division. Even the Center for Disease Control fails to properly acknowledge women’s pelvic-floor disorders, he adds.

“Women’s health gets the short end of the stick on dollars and education,” Kleeman says. “It’s really a travesty.”

In 2011, the American Board of Medical Specialties finally approved board certification in urogynecology, including a madatory seven years of training after medical school — the same length of time required of neurosurgeons. Kleeman is one of only 43 certified doctors in Ohio.

As underutilized and misunderstood as the field is, Kleeman recognizes that women’s health is even further behind in developing countries like Tanzania, which is why he traveled there last October on a humanitarian medical mission.

The mission was organized by Light of the World Charities, a Florida-based nonprofit organization comprised of volunteers who provide medical care and supplies to hospitals in the United States and abroad. Kleeman first worked with Light of the World on a mission trip to Honduras and has also volunteered in Haiti.

The need for volunteers in Tanzania seems particularly urgent. In Asia and sub-Saharan Africa, which includes Tanzania, there are an estimated two million women suffering from an obstetric fistula, a hole in the birth canal resulting from obstructed labor. Without access to proper emergency care, afflicted women can suffer from permanent incontinence — a disorder Kleeman says often leads to social repercussions.

“Those women (who suffer from incontinence) are ostracized and left to fend for themselves,” Kleeman explains. “They can’t even work as prostitutes, as demeaning as that would be.”

He and a group of nurses and anesthesiologists traveled to Tanzania to practice general gynecology for two weeks at St. Joseph’s Hospital. Founded in 2001 and led by Sister Urbani Lyimo, a nun and physician, the hospital sits below Africa’s mighty Mt. Kilimanjaro in the town of Moshi. Kleeman says his arrival was a bit surreal.

“I was here (in Cincinnati) on a Saturday watching my son run a cross-country meet,” he remembers. By Sunday, he was in Moshi. “I woke up, and I was in an operating room again — just like here, only people were speaking Swahili.”

At the end of his second day, before Kleeman was even able to find his bearings in the foreign terrain, he was faced with a doctor’s greatest challenge — an emergency hysterectomy on a mother whose newborn baby was struggling to survive.

Without enough units of blood, the mother eventually bled to death. Although the doctors were able to briefly revive her baby girl, she also died from respiratory complications.

“We’re not use to seeing that," Kleeman laments. "To see a mom die just because she bled to death, and we’re thinking, ‘This is preventable.’” The next day, another baby and a young man died at the hospital.

The nuns weather the highs and lows of the hospital 52 weeks out of the year with admirable compassion, Kleeman says. And showing that same compasion to their volunteers, they arranged a Serengeti safari for them.

Adjusting to the change in scenery, however, was difficult, Kleeman admits. “To go from seeing people die, and then I’m on this safari, sleeping in nice hotels and drinking beer. It was a lot to process.”

Fortunately, the hospital kept him busy, often asking him to assist with medical matters outside of his field. In one case, Kleeman was asked to treat an 18-month-old girl with a congenital abnormality. In the United States, a patient that young would see a specialist at a children’s hospital, he points out.

When he needed further expertise, Kleeman would call colleagues in Cincinnati, which seemed way too easy. “I can’t get reception on my cell phone here (at Good Sam), but my phone worked great out there in the Serengeti at the base of Kilimanjaro,” he jokes.

In other cases, culture factored into a patient’s medical care, and Kleeman had to rely on the nuns. When he tried to explain to a patient, in blunt terms, that she would not be able to get pregnant due to an infection in the fallopian tubes, one of the nuns firmly corrected him.

In Tanzania, a woman who can’t have children isn’t worth the water in the toilet, the nun told him. “You tell them we did everything we could, and let’s see what happens,” Kleeman learned.

“You always leave hope. You have to be respectful. As much as it doesn’t make sense to us sometimes, we’re still visitors.”

Even though he didn’t always understand their culture, he always knew one thing: People universally want the same things.

“People are people. They want to raise a family. They want their kids to grow up and do well. And they want to have enough food. I mean the struggles, whether you’re in Italy or here, they’re exactly the same."

His compassion for others can be attributed to his lifelong faith. On the wall in his Clifton office hangs a picture of Mother Teresa, whom Kleeman says is one of his favorite people. Yet regardless of religion, he sees examples of compassion all around him.

“On many of these mission trips, you meet people from all walks of life that have very different points of view, but at our core human value, people always want to give back,” he says. “I’ve never met anybody that didn’t want to do the right thing or didn’t want to help give back.”

Benevolence isn’t just a personal commitment for Kleeman. As a colleague and mentor, he encourages others to get involved, too.

Dr. Catrina Crisp, MD '13, has worked at Good Sam with Kleeman for almost five years. Two years ago, Crisp traveled to Haiti with him on a medical mission through Light of the World.

“It’s one of those things I’m glad Steve exposed me to because it will just become a part of what I do every single year,” Crisp says. “It’s a way of helping others in a place where not many people can get. To be able to help contribute is amazing.”

At the heart of Kleeman’s work is more than a desire to just contribute to the underserved. He is intent on taking the best possible care of any patient, Crisp insists.

“I have never met a single patient who didn’t just have the utmost respect and adoration for him,” she says. “He’s a genuinely good human that just wants to take care of people.”

Although Kleeman is dedicated to giving back to others, what he gets in return is much richer, he freely acknowledges. The doctors and patients at St. Joseph’s Hospital remind him of the value of simply holding someone’s hand during a difficult time.

“We forget that," he states. "We get so busy in the rat race here. So I’m always more balanced when I come home than when I leave.”

In late March 2014, Kleeman’s passion for patients will extend even further. Sister Urbani, the lead physician at St. Joseph’s Hospital, will visit Good Sam to tour the facilities, consult with staff and spread the word about medical missions. Kleeman also recently set up a medical mission fund for future missions to Tanzania.

Nevertheless, there are ways to help in our own backyard, Kleeman adds.

“Sometimes we forget that if you drive downtown or in Lower Price Hill, there’s a lot of poverty here, too,” he says. “You don’t have to go all around the world to help out.”

Elizabeth DePompei is a UC journalism student and writing intern with UC Magazine.


Posted Feb. 28, 2014