"I remember once when I was sick, my parents took me to the hospital and they wouldn't treat me, not without money up front," says Bertrand Fote, an emergency physician at the Union Carolinas Medical Center in North Carolina. "My parents drove me to different hospitals and no one would see me. We had to call my uncle and have him bring money so that they would treat me at the hospital."
If that sounds different from your emergency department’s diversion protocol it’s no surprise. Fote grew up in the Republic of Cameroon, a country on the west coast of Africa more notable for its soccer team and wildlife parks than for its heathcare infrastructure.
His childhood struggle of trying to get medical care in Cameroon is typical. According to Fote, the government runs most of the hospitals and sometimes neglects for months to pay its employees. In order to survive, the hospital workers demand money before providing treatment.
“You can literally sit in the waiting room and die if you can’t pay up front for care. Also, if you want them to use clean syringes or bandages you have to provide your own.”
While he was at an all-boys Catholic boarding school, Fote was put in charge of the infirmary. When a student needed to go to the hospital, Fote often went with him, and tried to help the student get quality care. These encounters with his country’s healthcare system motivated Fote to change the system. From that point on, he knew he wanted to be a physician.
Despite his obvious scholastic ability (he placed first in the national exam taken by all Cameroonian students who complete high school) and support from his two uncles who lived in America, it was not guaranteed that Fote would study medicine in America. Obtaining a visa could take years, and even if he received the visa, he would need the money to get to the United States. Without knowing it, however, Fote already had the solution to both of these problems.
During the summer before his final year of high school, Fote wrote a math book designed to help students prepare for the national exam. He was 16. It started out as a lark, something to do to fill his time, but the men at the embassy interviewing Fote for a visa took it quite seriously.
“I went into the interview and told them I wanted to study in America. They asked me questions, but didn’t even seem to be listening to me. I decided to show them a copy of the math book I had written. It contained trigonometry, algebra, calculus. When they saw that math book, they stopped asking me questions. The next thing I knew I had my visa. Everyone else they interviewedthat day was denied a visa.”
Now Fote had his visa, but still needed money for his flight. Once again, the math book paved his way. Fote managed to get his book published, and schools across Cameroon began using it to help students prepare for the national exam. The money from the book paid for his flight to America, and today, fifteen years later, Fote’s parents still receive money from the book’s sales.
In 1994, at the age of sixteen, Fote was in Washington D.C., living with one of his uncles and majoring in electrical engineering and pre-med at the University of the District of Columbia. Although he graduated at the top of his class for electrical engineering, Fote was still determined to go to medical school, despite the difficulty to international students of gaining entrance.
“This was a tough time,” he recalls. “I worked full-time all through undergraduate to pay for school because they wouldn’t give financial aid to international students. Then for medical school applications, I’d have to send in money with the initial application, and then again with the secondary application, only to be told that they didn’t want any international students.”
Finally, Fote received an interview with Howard University. Shortly after, he learned he was in—but how would he pay for his schooling?
Fote’s uncle co-signed a loan with him, and Fote worked full-time during medical school. For the first time in his life, his grades suffered. But he made it through, even squeezing in a MBA in business school during his residency at the Bay State Medical Center in Springfield, MA. After working full time and going to medical school, residency seemed like a breeze. Plus, as Fote puts it, “I’m crazy. I think I have ADD. I just can’t seem to keep still.”
His energy seems more motivated by conscience, and the profound understanding of what the American medical system can offer. “My background affects me as a doctor. It makes me feel human...I understand immigrant’s plights more. Back in residency, this one patient came in with chest pain and we took care of him and got him admitted. I didn’t do anything out of the ordinary—same thing I do for every patient. And when I go back and see him later, he’s crying like crazy. I was worried, and asked him why he was crying. He said he couldn’t believe that everybody gave him such good care. In his own country nobody ever cared for him like this, nobody wanted to take care of him, and here he is in a foreign land and we’re taking such good care of him.
"Some patients walk into the ED and act like they have a right to everything. I wish they could go to a hospital in my country and see how lucky they are. Some Americans don’t understand what they have.”