{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/9p2w37np6d/manifest","type":"Manifest","label":{"en":["Dr. Daniel Ostergaard"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eDr. Dan Ostergaard has a rich history in family medicine and has made many valuable contributions to the specialty. His parents were medical missionaries in India, and returned to Minnesota, where his father was a family physician, and his mother was a nurse. Early experiences included time on the Navajo reservation, where his parents were serving, boarding school in Minnesota, and medical school at the University of North Dakota. During medical school he became an activist in the Student American Medical Association. After residency he joined the Public Health Service as a commissioned officer and served on the Navajo reservation. He was recruited by the AAFP to serve as Assistant Director of Medical Education. He had a special interest in student interest and represented the AAFP on the Residency Review Committee He left the AAFP to serve as director of the University of Minnesota -Duluth Residency, then returned to the AAFP 3 1/2 years later as Director of Medical Education, and in 1983 became Vice President of Education and Science. \u003cbr\u003eBecause of his early background he had a strong interest in international activities and in 1999 assumed the newly created position of Vice President of International and Interprofessional Activities. This dual role involved working with the AMA and representing the AAFP in discussions with other organizations. He was the AAFP representative to the Council of Medical Specialty Societies and worked closely with other primary care medical associations. \u003cbr\u003eThe latter part of the interview covered his role with WONCA, the World Organization of Family Doctors. It is a rich recounting of working with family medicine in an international capacity, of attending WONCA meetings with his family (with some interesting anecdotes), and of hosting the WONCA triennial meeting in the United States. It is a colorful retelling of his interesting career and experiences and his contributions to family medicine throughout the world.  \u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2006-07-19 (created)","2006-12-6 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history","interview"]}},{"label":{"en":["Agent"]},"value":{"en":["Don Ivey (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family medicine","family physician","Dr. Daniel Ostergaard"]}},{"label":{"en":["Subject"]},"value":{"en":["Daniel Ostergaard (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eDr. Dan Ostergaard has a rich history in family medicine and has made many valuable contributions to the specialty. His parents were medical missionaries in India, and returned to Minnesota, where his father was a family physician, and his mother was a nurse. Early experiences included time on the Navajo reservation, where his parents were serving, boarding school in Minnesota, and medical school at the University of North Dakota. During medical school he became an activist in the Student American Medical Association. After residency he joined the Public Health Service as a commissioned officer and served on the Navajo reservation. He was recruited by the AAFP to serve as Assistant Director of Medical Education. He had a special interest in student interest and represented the AAFP on the Residency Review Committee He left the AAFP to serve as director of the University of Minnesota -Duluth Residency, then returned to the AAFP 3 1/2 years later as Director of Medical Education, and in 1983 became Vice President of Education and Science.\u0026nbsp;\u003cbr /\u003eBecause of his early background he had a strong interest in international activities and in 1999 assumed the newly created position of Vice President of International and Interprofessional Activities. This dual role involved working with the AMA and representing the AAFP in discussions with other organizations. He was the AAFP representative to the Council of Medical Specialty Societies and worked closely with other primary care medical associations.\u0026nbsp;\u003cbr /\u003eThe latter part of the interview covered his role with WONCA, the World Organization of Family Doctors. It is a rich recounting of working with family medicine in an international capacity, of attending WONCA meetings with his family (with some interesting anecdotes), and of hosting the WONCA triennial meeting in the United States. It is a colorful retelling of his interesting career and experiences and his contributions to family medicine throughout the world. \u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471","type":"Canvas","label":{"en":["Media File 1 of 3 - Ostergaard_Daniel_Pt5_07_a.wav"]},"duration":3503.34893,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/280/471/original/Ostergaard_Daniel_Pt5_07_a.wav?1751474405","type":"Audio","format":"audio/wav","duration":3503.34893,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471/transcript/81506","type":"AnnotationPage","label":{"en":["Dr. Daniel Ostergaard Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471/transcript/81506/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Today is Wednesday, July 19, 2006. My name is Don Ivey, I’m Manager of the Center for the History of Family Medicine, and today I am in the office of Dr. Dan Ostergaard.  \n\nDr. Ostergaard, can you give us your present title now? \n\nPresent title is Vice President of International and Interprofessional Activities of the American Academy of Family Physicians.\n\nAnd today we are going to be conducting the first part of an oral history. Let’s start at the very beginning. Can you tell us where you were born and tell us a little about your parents? \n\n\nI am the product of medical missionaries and therefore that is very much formative in everything I have done in my entire life. I was born in Fergus Falls, Minnesota, February 22, 1947. And at that time my dad was about 50 years old and my mom about 40 years old and I was the youngest of three children. My dad was a physician, a general practitioner with extra training in surgery. And he had had a term of service deep in the jungle of India with a group which was primarily Scandinavian called the Santal mission among the Santali people of the Bihar Province of India. And Bihar was and remains probably the poorest and least developed province in India and is the home of people such as the Santali people who are untouchables. They are below caste. As you know, the caste system has been very, very prominent in that country and although now banned it still exists. So my dad was there about eight years running a hospital along with some other physicians and pastors and then came back on furlough to the United States, met and married my mother in Minneapolis and they went back together. My mom and dad went back as doctor and nurse. And while there my brother and sister were born and my dad delivered them because he was the only doctor anywhere near where they were. And they basically spent their first years in India. And I am the only one in my family who really spoke English for a first language. My dad spoke Danish, my mother Norwegian and my brother and sister Santali. That timing became a problem because India was gaining its independence from Britain and the Second World War was breaking out and they had to be evacuated, I think it was in ‘44, by a U.S. troop ship. And it was a very, very difficult thing. All of them were in ill health. One of my siblings nearly died. My dad nearly died. And they were evacuated from the jungle to a warehouse in Bombay where they lived in the warehouse for six weeks waiting for evacuation out of India. And finally a troop ship came and picked them up. So they went with a troop ship for six weeks not really knowing where they were going, zigzagging across the ocean avoiding the German boats. And they actually didn’t know where they were until they sailed under the Golden Gate Bridge. And I can’t remember what year that was. It must have been about ‘45.   \n\nI then was born when they came back to the states and settled in a little town called Fergus Falls, Minnesota where I had been born and whereas this day my mother still lives, over 100 years old, living in a nursing home in Fergus Falls. My dad then for the first time at about age 50 set up general practice where he actually made money. He had basically been a missionary his entire life until age 50. And then I moved to Evansville, Minnesota, a little town of about 500 or maybe 450 in west central Minnesota where I spent the first seven grades of my life. And when I was, I think, thirteen we moved. Again, my dad had the desire to serve God and people in a mission capacity and moved to the Navajo reservation of Arizona. In eighth grade I was the only white kid on the eighth grade basketball team at Chinle, Arizona. There was no school where my parents were in this little mission of Rock Point, Rock Point Lutheran Mission, so they tried to find a place for me to go to eighth grade and sent me away to live with a family I didn’t know fifty miles away in Chinle, Arizona and that’s where I spent the eighth grade. Then in ninth grade that family had moved away and there was still no school, so I was dispatched back to Fergus Falls, Minnesota where I went to a private Lutheran Christian high school boarding school and went there all four years. Now obviously the time on the Navajo reservation as a kid coupled with the fact that we had East Indian folks coming through our home all the time as a child and the entire family dynamic that what we must do on this earth is to serve God and man and serving God is best by serving people influenced everything I did from that point.  \n\nIn high school in Fergus Falls I met my wife Ruth. She was also at that boarding school. And after college, we went away to our respective colleges, we got married. While in medical school at the University of North Dakota when we had just gotten married, starting medical school in 1969 at the University of North Dakota, I started getting involved in community health activism. I had been involved in student political activities as a college student and in medical school I got involved with the Student American Medical Association Indian Health project. And to make a long story short in that regard, it became clear to me to get things done, to make changes in policy of medical schools or of any jurisdiction you needed to be involved in the political process. So as much as my interest was in providing health care to in this case American Indian populations, I realized you had to become an activist to do that. At that time the University of North Dakota was only a two-year med school and everybody transferred for their second two years. I transferred to the University of Texas Southwestern in Dallas. And while there became involved as a leader in the Student American Medical Association both regionally and nationally. And I kind of got on a soapbox not only about Indian health and community medicine but about the fact that universities, medical schools needed to be intentional in developing ways to meet the needs of the communities in which those medical schools lived and became a little bit visible. I was the American student representative to Federation of State Medical Student Associations meeting in Copenhagen in the early ‘70s. And I was the U.S. student representative to that meeting. My own dean came along to that meeting; it was the meeting of the World Medical Association. I think what he wanted to do was see what I was going to say in that rather large international forum about my own school because I had been critical of the fact that my school and most schools didn’t really reach out to the communities and serve the communities in which they lived. And that translated into the need for a competent generalist physician and in my dad’s case that was a general practitioner. And while all of this was going on the specialty of family practice was being formed. And I immediately gravitated toward those notions of family practice because our specialty was created at just that time, in the late ‘60s and on into the early ‘70s. While in med school I co-directed a national student Indian health project, living on the reservation, and that was for medical, dental, nursing and pharmaceutical students. And we spent the summer with various projects on several organizations. Ruth and I lived on the Navajo in a floor in an abandoned apartment that summer but traveled around to other reservations supervising these student projects. That also made it clear to me that what I really needed to do was right out of med school get the broadest training I could to go take care of people. So although I applied for family medicine residencies very early, I actually just did a rotating internship. I did what I could find as sort of the most blood and guts internship I could find to get the most experience, work the hardest. And right after internship went back to the Navajo reservation now for the third time on the Navajo and worked as a commissioned officer in the United States Public Health Service and in the Indian Health Service specifically. That was a great experience and I liked it very much. And we still identify with a lot of the young doctors with whom we worked there. But then I had created a certain amount of visibility for myself in my medical student days and in my internship time. While I was an intern I was the first resident or intern on the AMA Council of Medical Service as student activism was reaching into the AMA at that time. And as such, while in my second year of service in Shiprock, New Mexico I was approached by the American Academy of Family Physicians to come to Kansas City to work as Assistant Director of the Academy’s Division of Education. And the whole purpose of that was to be a counterpoint, an advocate of, a recruitment to family medicine to support resident and student activities of the AAFP. And I did that and was the second assistant director of the Academy’s Division of Education, the first being Bob Graham who along with his boss, Dr. Tom Stern, recruited me back. And when Bob left here as Assistant Director of Education to go to law school I came and assumed that position working for the director of that division, my mentor Dr. Tom Stern.  \n\nWhen arriving at the AAFP in the big city of Kansas City from the incredible rurality of the Navajo reservation in Shiprock, New Mexico was a bit of a reverse culture shock. Indeed, I came here having lived around but never in a big metropolitan area and it was an interesting experience. We had for the first time purchased our own home, I guess it would be a condo in a line of row houses and we had a little baby and were going to have another one. The Academy was also a very interesting experience for me. I had certainly been aware of the Academy and admired the Academy and had read Academy stuff ever since I was early med school. But when I got here I was still wearing western clothes and my best neckties were bolo ties. And I guess I probably had a sport coat but probably no suit. It was a time when we did dress up for work more often and I was a bit of an outlier in the building because I sort of looked like some kind of a junior wannabe cowboy from the reservation. Also, in terms of social stuff it was a bit of a surprise to me because at that time the AAFP had quite a culture of excessive use. And it was astonishing to me how much and how often and in what settings people would use alcohol. I was a teetotaler but it was kind of a shock to see that little element of a social difference between a group of physicians in the middle of a reservation and a group of professional staff who travel to meetings all the time in a place like a national specialty society. But it was a real challenge. And one of my main responsibilities at that time, and I did write a paper for the Board of Directors at that time, which was after I had been here maybe a year, the AAFP planned to augment student interest in family medicine. And that was probably in 1977. And it was the same issue that we have right now in 2007. The rate limiting step to the growth of our specialty is student interest and if student interest is not there, there will be no people who will be our progeny and we will no longer have a specialty. And it was exactly the same way in my first tenure at the Academy exactly thirty years, in the middle of 1977, as now in 2007. In fact, we probably ought to go dust off that paper. It’s probably in the archives someplace. And give it to Amy McGaha and say “Here it is, Amy, this is what we said 30 years ago. Where are we now?” So a lot of my work then was with the medical students encouraging them and figuring out ways to get them into family medicine and residencies and working with the residents to get them involved with the Academy and to see if we as the Academy could support their needs, their work, their life as students and residents in family medicine. As part of that we went to all of the usual sites where students would congregate such as the AAMC, the Association of American Medical Colleges, and certainly AMSA, the American Medical Student Association, which at that time was called SAMA, the Student American Medical Association, although it wasn’t part of the AMA.  \n\nSpeaking of students at the AMA, we at that time helped develop what is now the AMA Medical Student Section. Because at the Academy we had a very sophisticated and detailed plan and activity involving students in our work. In fact, the Academy student activity before I got here was the one which SAMA used to identify students for AMA, student presence on commissions of the AMA. But we were instrumental in and ours was really the template for medical student and then subsequently resident activities at the AMA. And again, the AAFP, and this predated me, was the leader in the country in involving residents and students in the large, broader, major political and project activities of a specialty society. As part of that experience working with my boss and mentor, Dr. Tom Stern, who was then Director of the Division of Education, Tom and I would be the ones who would attend meetings of the Residency Review Committee for Family Practice on behalf of the AAFP. And indeed I remember in those early days of ‘77 and probably actually ‘76 going to meetings where Tom Stern and Nick Pisacano, the late CEO of the American Board of Family Practice. So Tom and Nick and I and very few others, one or two others, would sit around tables and make the entire revisions to the special requirements for family medicine residencies. There was no major multiple organization sophisticated way to do that. Certainly there was in RRC, which had the parent organizations of the AAFP, the ABFP and the AMA Council of Medical Education. But we basically sat down and did it and then the various parent organizations would adopt it. So part of my responsibilities while I was here as Assistant Director of Education were beyond the issues of resident and student. They were into all the issues of family medicine education from the academic parts of medical schools to the requirements for accreditation of residencies and for the various elements of continuing medical education. And Dr. Stern had initiated the Home Study Self-Assessment program. And it is very similar today, 30 years later, as it was then. And he also initiated the Residency Assistance Program, RAP. And actually I was involved in all of those early meetings before RAP became an entity. Even before I physically came to the Academy, I came in in a few special trips to help with that and had the great honor and privilege of working with many of the pioneers, many of whom now are dead, pioneers in our specialty to develop RAP and make impact on the Residency Review Committee as I have just mentioned. So it was an incredible opportunity for a young guy under 30 years old in the very early stages of our specialty. What that also did was allow me the opportunity, by attending all the Residency Review Committees, to become somewhat of an expert on the structure and function of a residency and certainly the requirements of a residency. And Tom Stern and I went on the road in consultations before RAP. We did consultation after consultation, in big cities and in little cities, and sometimes on a tour through a whole state as we did in Alabama together in about 1976. And those consultations that we did before there was a Residency Assistant Program formed the basis of the entire RAP consultation process. So what we then knew as RAP was a direct result of the AAFP consultations that we did.  \n\nIndeed I need to step back and say, if I haven’t said it earlier, how Dr. Stern and I became acquainted. When I was an intern at St. Mary’s Hospital in Duluth, Minnesota in 1974 or maybe late 1973 that rotating internship was beginning the metamorphosis into a family medicine residency and St. Mary’s Hospital called the AAFP to get a consultant to help figure out how we can make that transition. Well, the consultant was Dr. Stern. And I as somewhat of a leader among the intern class was the intern assigned to spend the day with Dr. Stern showing him the hospital and talking to him about what we did in curriculum. And Tom and I got to know each other then. He was very intimidating. But I did not let him intimidate me and I think the fact that I didn’t let him intimidate me but I was still pleasant with him in his curmudgeoned way allowed us to keep in somewhat contact from even the time I was an intern through my time in the Indian Health Service and until he and Bob Graham recruited me back to this position. So what Tom was doing in consultation I then started doing as soon as I got my feet on the ground at the Academy and therefore the rudiments that we now have as the RAP Consultations.\n\nWhile we were here doing the professional work for the Academy we also had our second child, Josh. I will mention that here and then maybe come back to family later. But I’ll mention it here because it is a story which was emblematic of the way we tried to promote family medicine. When we moved to Kansas City we got pregnant soon after we got here. This was the first time we moved here, in 1976. And I then, of course, because I had to be a loyal person and practice what I preached about residents and residencies, I called Dr. Jack Stelmach who was the Director of the residency at Goppert Family Care Center at Baptist Hospital and said we need a family doctor; we just moved here and we don’t have one. Because I thought I was a big deal, I was thinking, of course, Jack would give me a faculty guy as our family doctor, or maybe the chief resident. But Dr. Stelmach gave us a first-year resident as our family physician and that was okay because I had to practice what I preached. And he was a wonderful guy, a young kid named Bruce Preston. So the problem was though when we got pregnant I did the mathematics, looked at the calendar, and asked Bruce have you had OB yet? No, he hadn’t had OB yet. Well, we’re going to have a baby, Dr. Preston. Yes, I think I will have OB before the baby comes. So we were a little concerned about that. And yes, he did have his obstetrics rotation. And that’s a good rotation at Baptist so we were feeling pretty comfortable that this young guy would be able to deliver our baby. And then I was afraid that when Ruth went into labor that Bruce would be on some rural rotation somewhere or in the E.R. at Children’s Mercy or something where he couldn’t get away to come and deliver our baby. Sure enough, when Ruth went into labor and we called up and tried to find our doctor, Dr. Preston was on a rotation at some other place that was hard to get out of. So we went to the hospital anyway and the nurses checked us out. And at about five or six centimeters the attending physician came in, which was good because then we knew we had somebody there to deliver the baby. But Dr. Preston still wasn’t there. So at about seven or eight centimeters Bruce rolled in smiling his big smile (big dimples, still has them) and delivered Josh. So the attending was there. The first-year resident was our family doctor and delivered Josh. He did the circumcision and the postnatal care. In the entire antenatal period we never missed a prenatal visit with Bruce. It worked fine even though in the first year a resident was only in the office a half day a week. And it was a wonderful experience and very much what we were promoting in terms of a resident’s experience with a real family. We already had our young daughter Heidi at that time who was about three. The problem is at [  ] months of age, and I happened to be in town even though I traveled a lot, I was at the office of the Academy and Ruth called me one morning and said, “Ddo you know Josh had a cold this morning when you went to work?” and I said yes. And she said, “But now he’s got 104 fever and it won’t go down when I put him in the bathtub and cooled him off and he’s lethargic and he’s really, really sleepy and he won’t eat.” And I said tell me more and she said when I move him he yells. I get a little choked up just thinking about it because it was so scary. So I told Ruth to take Josh to the emergency room at Baptist which she did. I knew in my mind he had meningitis and I was remembering that one of the last patients I had on the Navajo reservation was a child about that age who came into the clinic where I was working and had been to the medicine man before he came to the clinic and was ashen and had the same kind of symptoms that Josh did. I had taken that kid in my arms, this little Navajo baby, right from the clinic to the hospital. Did the lumbar tap on him and the spinal fluid on that little kid was cloudy which confirmed my diagnosis of meningitis on that kid. And even though I started him then with IV antibiotics, probably everything I had in the hospital, I don’t remember, because we had to start him before we had any cultures or anything - and that child died. And, of course, that’s what was going through my mind as I went to the emergency room where I met Josh and Ruth. But, of course, Bruce Preston, our doc, wasn’t present at that time. But that’s the way the system works too because whomever ... Actually, we didn’t go to the emergency room, we went to the clinic at Goppert. And that system works right because the docs there saw him, whoever was on call, the resident and the attending physician. And they also took care of him, did the spinal tap and got the diagnosis of meningitis on Josh. And with IVs running put us in an ambulance and sent us to Children’s Mercy because it was obvious he was really sick and needed to be in the neonatal intensive care unit. So, again, the system really worked because in the NICU there is a team and there is a system. And outsiders, be they residents or faculty or whatever, really must respect that system. So our attending physician, a guy named Stacy, forgot his last name, handed him off to the NICU people. And long story short, we still hadn’t seen our doctor. But after Josh got admitted and IVs flowing and was pretty much unconscious, there came Dr. Preston, smiling, at Children’s Mercy. He got off of wherever he was on his rotation, came to Children’s Mercy. And I guess his smile was probably too big because we were obviously pretty scared and blue. But he brought a breast pump - and nobody had thought about that. Ruth was nursing Josh and now he was too sick to nurse. And the only one in the entire system who thought about the fact that she would need a breast pump was Bruce Preston, our first-year resident who was our family doctor. So to make a long story short again it was a really rocky course. Josh was in the unit for maybe ten days to two weeks. He did have seizures on the third day. He did have a bilateral ventricular tap. But he turned out fine. He was discharged and after some follow-up visits with the Children’s Mercy infectious disease folks, all the care went back to Dr. Bruce Preston, the first-year resident, and that was the story of Josh and our exposure to being the patients as a family of a first-year resident.\n\nNow back to the chronology of our work at the Academy. The background I had had with our aspects of medical education and particularly the criteria and the teaching of so many people in how to run a residency made me I guess a target for recruitment out of the Academy to residencies. So when a position became available being vacated by another good friend of mine, Dr. Bill Jacott, who was the first Director of the Duluth Family Practice Residency, and Jacott was going to go back into practice. So he and the Duluth officials recruited me out of the Academy to come back up to Duluth where I had done my internship. And now it was a full-fledged family medicine residency and to be the director of that residency, which I did. And I guess I was up there maybe three and a half years and then was recruited back here. So it was sort of a ping-pong from Duluth to the reservation to the Academy to Duluth and back to the Academy where I now reside. But when I came back to the Academy as then the Director of the AAFP Division of Education it was the fall of 1981. I had left as Assistant Director of Education, came back as Director of Education, because Dr. Stern who was my mentor in the first stint and my mentor and boss in the second stint had been promoted to a new position of Vice President for Education, I think it was Vice President for Educational Science. So I came back working again for Tom and had several really interesting and fun Assistant Directors. There were a couple of different Assistant Directors of Education at that time. When I came back there was a guy named Dr. Steven Brunton. And Tom as VP, me as Director and Steven as Assistant Director did all the things that one must do as director of a division of education. That position really only lasted for me for two years because in late 1983 Dr. Stern largely for health reasons had to retire or at least retire from full-time work. And he left the full time position of the Vice President and I was asked to assume the role of AAFP Vice President for Education and Scientific Affairs at that time in February 1983 and did that for the next sixteen years, I guess, until the spring of 1999. And in that time, the last maybe ten years of that date, we had recruited and had in place extremely competent and wonderful directors of the Divisions of Education and Science. They are both here still. Dr. Herb Young was Director of Scientific Activities Division and he still is. Dr. Norm Kahn we recruited out of California and he became the Director of the Division of Education. And thinking about Norm Kahn for a moment, when Dr. Jane Murray left as Director of Education and went to KU where she stayed for several years I was thinking about who in the country would be the prototype for what we need as the Director of the Division of Education. And I came up with Norm Kahn as sort of a prototype with all the attributes and experiences necessary to be the Director of the Division of Education. And then I said to myself, if Dr. Kahn is the prototype then why not go after Dr. Kahn? And then I remember that he was a native of Kansas and had gone to KU and I figured this is a natural. And we therefore recruited Norm and he came and did a great job. And by the early ‘90s basically, or mid-‘90s, I wasn’t doing much in the areas of education and science because even though I was the VP for Education and Science I was doing mostly administrative stuff because Norm and Herb were doing such a great job in the overall running of their areas and hiring their people and managing their people. At that same time with Bob Graham as the EVP. He had come back in about 1984 or 1985 as EVP. And I had talked to Bob about a couple of real needs we have and I started doing these as VP for Education and Science. And those were real needs and nobody was doing them were to have a much more vigorous role in fostering the relationships between the AAFP and the other medical organizations in the country. And I had already been very, very active in the AMA both as a staff member here at the Academy and back when I was an intern I was the first resident on the AMA Council of Medical Service. And when I was a student I was working with organized medicine as a leader in then SAMA and also in terms of feeding into the AMA early development of student activities at that time. So I realized that we needed to have a better and more detailed relationship with the AMA and the Council of Medical Specialty Societies and the specialty groups and all of these professional groups and started doing that. So for much of the time between maybe the early ‘90s and the time I changed positions, that was what we were focusing on.  \n\nThe other and just as large need was that of international. There was really nobody doing international except what I was trying to do on the side as Director of the Division of Education a little bit and then certainly as a VP. The World Organization of Family Doctors, WONCA, was something in which the Academy was one of the pioneer organizations and we had had a past president of the Academy as one of the early presidents of WONCA, Dr. Ed Kowalewski. And we needed to devote more time to WONCA and to other international activities. It was pretty clear to me that our members were developing more and more interest and relying more and more on the interest in international work and relying more and more on the Academy to provide them networking capabilities to tell them who else is doing something in wherever, Rwanda or Honduras or Pakistan or wherever. And we needed to develop some resources to be of service to our members and to be responsive to requests we had from abroad for this kind of a question. Hey you at the American Academy of Family Physicians, we know that you are developing in family medicine in the United States and it’s being very, very effective in your country. We know we need a competent generalist physician in our country. What can you tell us? So we started talking about and actually started initiating some sort of RAP-like international consultations. It wasn’t officially part of RAP but we would tap into RAP consultants who had some international background or interest and send them abroad and they would do these kinds of consultations. And I did some of that as well. So as the ‘90s progressed it became more and more apparent that this was a huge additional job, the development of international relations and work in the development of interprofessional relations and work, and Bob Graham and I in early ‘99 or late ‘98 started talking about maybe we should create a new VP position and that is what we did. And, of course, the “we” is Dr. Graham and me but it was his call as the boss. And he created the position and I filled it called Vice President for International and Interprofessional Activities. At that time we then elevated Norm to be Vice President for Education and Science and also divided what was then the single Division of Education into two Divisions of Education. One of CME and one of Medical Education. So we only had one education structure in the organization until April of ‘99 when I assumed the new position of VP and Norm assumed my position. He then inherited really a larger job because we now had two different Divisions of Education - one for continuing medical education and one for resident and student, medical school, that kind of education. That then brought us up to my current position starting in the spring of ‘99 and now in the spring of ‘07 we have been doing this for the past eight years.\n\nI’m extremely fortunate to have all of those jobs. But the one I am now in which has tastes of many different kinds of activities. It is stimulating and in my view hopefully worthwhile. Basically currently as the job has evolved in this new VP position for the last seven or eight years, at this point it really has three components. One of those thirds and probably the largest third is that of being a VP of the organization and as such working on the issues of running the organization from the staff side along with the EVP, Doug, and a deputy Todd [Dicus], and five other vice presidents. And that team of eight basically meets very, very quickly (?) frequently for very long periods of time and talks about all aspects of the organization, not just our own respective areas. So all of us contribute to the others’ areas. And as time has passed in this new position, particularly since Doug has been here as our EVP, and the staff has grown substantial and the membership grows, although not as much as we like, the organization gets bigger and far more complex. So our role as the VP has occupied more time than the other two-thirds and that is an increasing responsibility. The second third is the third of the interprofessional relations. And that probably does occupy one-third of our time. And Jane Pyszczynski, my assistant, is an absolutely incredible assistant and an absolutely incredible person in coordinating with me the interprofessional activities such as the AMA and figuring out how we are going to increase our presence at the AMA or not decrease our presence and the politics and the people of that and how our own delegation works and how that delegation works relative to the Academy’s Executive Committee because we have always had our Academy Executive Committee as part of our AMA delegation. We used to have only one delegate to the AMA when I started this work but the Executive Committee also met for a day or two at the same time. Now we have sixteen delegates to the AMA and the Academy Executive Committee comprises five of those sixteen delegate slots. And all the staff positions are ultimate delegates. So the interprofessional part of the job has grown remarkably also even only if you consider the AMA, which has increased very, very much. We were instrumental in starting our AMA group of four which is the AAFP, the American College of Physicians, the American Academy of Pediatrics and ACOG, the American College of Obstetricians and Gynecologists. And we four specialty societies meet at each AMA meeting and as sort of quasi-primary care groups get our heads together and think through what are the issues about which we may have common ground that are facing the AMA and what are the issues that any one of us of the four organizations may be bringing to the AMA that a) we may get the support of the other three groups or b) we may just need to recognize that this is a conflict area and we simply give the other three groups a heads-up about the fact we are bringing something to the AMA that we may have to agree to disagree on. So a lot of my work is in that regard, helping sort that out and advising Doug as the EVP and advising the Academy’s Executive Committee as well as the full delegation including the interprofessional part that Jane and I do. Our relations with some of the organizations I mentioned earlier, the Council of Medical Specialty Societies of which I am currently on the Board of Directors, the treasurer. I coordinate the little AAFP/ACOG liaison group which meets once a year to try to anticipate, head off and deal with any problems that occur between OBs and family doctors in this country, usually around OB privileges and other activities with many other groups.  \n\nPart of my job that people have no idea about except probably the Academy’s Executive Committee and Board, is that it falls to me to analyze approaches we get from all kinds of professional societies, medical specialty groups, when they want to do something with us. Because we are blessed and cursed by being the broad specialty society; our activities are similar to that, in some small way at least, of almost every other specialty society. I’ll give you a couple of examples of this year, actually last month: Last month we had had overtures from the American Physical Therapy Association, the American College of Nurse Midwives and another one which escapes me at the moment. But as an example, when those groups, in this case very specifically the APTA and the ACNM, contacted us. They request high-level meetings of our presidents and EVPs and the highest leadership of the organization which we cannot accommodate as the AAFP for every organization in the United States. So part of my job which is really under the radar screen is to evaluate those. Another one in February was the American Dental Association, the ADA. And we had overtures from all three. And we cannot dispatch our President and Board Chair and EVP to all of these things; it would gobble up their time in a fashion that is not at all realistic. So in each of those three cases, in February of this year I went and met with those three organizations alone, just as an individual, to meet with the appropriate staff people. And in most cases it was either the highest level or the next highest level of the staff. In the case of the Physical Therapists it was all of the senior staff. Talked about with them what really can we mutually identify as things good for our members and their members. And we usually can do that, find common ground on some things and as staff, me from the Academy and they from their respective organizations as the staff, think through what should be staff-level discussion and what should be board-level discussion. And in all three of those cases that I just mentioned the resolution was I thanked them for thinking of us and they thanked me for coming to visit and in all cases we decided that at this stage it would be best to maintain contact with me being the Academy point person and someone else in their organization, senior staff for being the point person from that organization, and to communicate directly. And then I would refer here in the Academy to whomever was the right staff-level person. And always remember that if it needed Board discussion, I would bring it to the Board or to the right Board people or to just Doug and the Board Chair. Another one that is on my desk this week came from a member of ours who is a go-between between us and between the quad A.I., the American Academy of Allergy, Asthma and Immunology. And Dr. Stoloff who is a member of both organizations, with whom I have worked in this exact capacity over the years, called me up and said that the NIH entity of the National, Heart, Lung and Blood Institute has released new asthma guidelines and wants to work with the Academy in a small group. When I get that written material I will refer it to Norm Kahn because all of the action will be in Norm’s area. And I made no promises. I don’t put Norm on the spot. But I say that this is not something at this stage which is Board-level stuff and that the proper staff level will figure it out. So that’s the kind of work we do in the interprofessional side of the organization - some of which is visible to people, some of which is totally invisible to people. I should do as a little postscript: When we get a letter addressed to the President of the AAFP that comes to the Academy as two or three of these that I just mentioned have been, I obviously talk to the President or the Board Chair and say look, we got this letter - I’m going to try to figure out how to handle it. And they know it and we write back letters over their signatures at the end of the process. We don’t just as the staff grab stuff that is addressed to the President without telling the President. But we put a plan together for the President or the Board Chair or the CEO to say this is how we are going to figure this out.  \n\nNow to the third tier which is occupying more of this discussion than the other thirds and that is the international role as VP for International, Interprofessional. The international role is the one that people most see about my work here at the Academy. And everybody thinks I am all of the time on some airplane going around the world. And actually that’s probably not very common at all. I probably don’t do more than four or five international trips in a given year. And I do far more domestic travel in a given year doing the two other parts of the job, the VP job and the interprofessional job.  \n\nSo the international job is fill in a gap, it’s creating by having a little office here for international activities, creating a way for the Academy to be responsive to the members’ questions, to be responsive to the members’ requests for some kind of assistance. And quite frankly and probably ought to be off the record but I will keep it on the record is part of our job here in terms of international stuff is when we get approaches from our members, try to give the member enough information about where they are going and what the pitfalls are and what they might want to do to keep them from doing harm. And I don’t necessarily mean doing clinical harm. When one of our members is going to go on two-week trips with their church to Rwanda to take care of patients, we obviously direct them to whatever is the other infrastructure in Rwanda. Point out if there is a WONCA group in that country that we ought to be in contact with. But we don’t try to get involved with their clinical work. We do say, however, such things as be really careful when you go to do your clinical work in that country that if you bring in medicine or if you start people on medicine or if you refer patients you see in this very poor underdeveloped place to which you are going, that it’s realistic and that you are not creating expectations that cannot be met after you leave or creating drug resistance after you leave or referring somebody to a clinic that may be elsewhere in the country to a hospital but to which they have absolutely no means to go. They have no way to get there. So kind of reality checks we give to the members. And I will give you another example of sort of preparation to keep people out of trouble: Another example from a year or two ago is one of our members was going to one of the countries in the Middle East and this is purely medical education and development of our specialty in the country and this individual knew the Minister of Health in that contract. And was planning to go into that country to go to the officials of the medical school and the Ministry of Health and say the way family medicine happens in the United States is the best way, it’s the only way and here is the American system, do it. Well, my job in that case was to try to give this person information about the fact that the Royal Australian College of General Practitioners, our sister organization in Australia, has had people on the ground there for years and they are working on it. And the model isn’t exactly the same because the Australian GP model is British and they don’t take care of patients in the hospital like we do. The British system is ambulatory. The American and North American system is ambulatory and inpatient care. Unfortunately this particular Academy member, extremely well-intentioned and very bright, didn’t heed those kinds of alerts and went in there sort of as an American on a shining white horse and offended everybody and semi-defeated the good work that had already been done by our colleagues from in this case Australia. And that is part of what we do in this office, try to give people when they call not just a handout to bring to wherever they are going and not just an e-mail address of a WONCA organization in that country to which they may want to make contact. But when we have the opportunity to do a little bit of a reality check and a little bit of reasoning with our member about what they might be doing. So we really serve a purpose. And the “we” that I am using is the collective “we” of this small office. It’s me with these three hats on. It’s Jane Pyszczynski as my assistant with the interprofessional hat on. But then we have a full-time international manager. And that’s the only person in the whole organization that does full-time international work. And the full-time international manager was a position we built up even before I took the current VP position. We started having somebody half-time to help me when I was Education with international stuff and now it’s a full-time position. And that person spends his or her time doing what I just described and doing what I’m about to describe as well. The other person in our office is Rebecca Jansen who is a senior project coordinator, or something like that, and she spends at least half of her time working with the international manager and me on international stuff and the other half-time helping with more of my VP kind of stuff such as the Academy’s Board of Directors Subcommittee on Screening which is a pretty big task in and of itself. So the “we” is our unit who helps advise the members. There are two other cohorts of customers, if you will, for our international services. One is the staff in the building and in our D.C. offices. When questions come to our D.C. office from an international perspective, they get sent to us and we try to help. When our people here in the Academy headquarters building, our membership folks do international membership and promote international membership, and that is done by Membership. But we in international advise the membership people on everything from where they might go to recruit to what the sensitivities are in their brochures to whatever other kind of advice.\n\nAnd throughout the building our Marketing people have a pretty substantial international marketing campaign. And I personally believe that a tremendous amount of our future is going to be beyond the people that are coming out of the residencies in this country because that’s pretty slow right now and it’s not increasing, it’s decreasing. So our future targets of this Academy in terms of marketing will be international. Particularly because English is being spoken more and more throughout the world and then when we have to translate, translation is becoming easier although very expensive. So international markets will be important to us as well as other markets in this country such as the osteopaths. And we have over the past six years, and I personally started this with the CEO of the American Osteopathic Association, very, very gently over the past six years developing a detente, if you will take a term from Soviet time, with the osteopaths and now have an increase and a valuable working relationship between the AAFP and the American Osteopathic Association, the AOA and the family medicine organization within the osteopathic physician world which is known as the American College of Osteopathic Family Physicians, the ACOFP. And we now meet every year in an official formal meeting with the leadership of the three groups and also in many other ad hoc venues around the year. \n\nSo the point of digression there was to say that our office not only is in the international but in other ways helps consult with the rest of the staff about things they are doing about which we have more background and knowledge and more contacts here. So of those three main cohorts of our international work one is the members, one is the staff in the Academy and the third is, and this is increasingly so, contacts from abroad from deans of medical schools, from academics in various countries, from ministries of health, from ex-pat family physicians who live in other countries now, whether or not they are doing mission work or whatever kind of work. And we are the ones who respond to those requests that come in and I will just give you a couple of real time examples. In two or three weeks the Ministry of Health of Singapore is sending a delegation to our office. And on April 13, 2007 there will be nine or ten officials from the Singapore Ministry of Health meeting with us all day long to learn more about the practice of family medicine in this country, the structure and the training for family medicine. Singapore as a former British colony is largely on a UK system and they want to just think about North American systems and they are going to Canada and the United States for a few days in April. Another small related example that is emblematic of what we do is just a couple of weeks ago I got a personal contact from an academic family physician in the Netherlands. They call themselves general practitioners but they are fully trained like we are. He is doing a survey on how we in this country handle after-hours care. How do our patients get care after the office closes in the afternoon? So it’s my job to find out who can best in the United States answer those questions. I actually can’t answer that one very well myself because it’s too broad, our country is too big. And maybe nobody can because our country is too big and there are too many systems. But it’s we then who respond to these kinds of activities when approached from abroad. \n\nA whole component that crosses all three of those sections is our work with the World Organization of Family Doctors. And I am currently sitting on the World WONCA Executive Committee and am Chair of the Bylaws Committee and have been working very, very actively and the Academy has allowed me to do this since about 1995 when I started getting most active in this just before we created a new position while I was still VP of Education and Science. So World WONCA is growing, it’s maturing. There are now over 100 organizations in World WONCA. And the Academy was one of the founders and is still the largest. And implicit in the fact we are the largest, we pay the most dues to WONCA than any other organization. So we work very closely with World WONCA.  \n\nToday is Wednesday, December 6, 2006. My name is Don Ivey, I am Manager of the Center for the History of Family Medicine. Today we are talking about with Dr. Dan Ostergaard and we are going to be talking about WONCA as the third part of our interview series with him. \n\nDr. Ostergaard, what is WONCA? Tell us a little bit about what it is. \n\nWONCA is a very odd acronym for an organization, the short title of which is the World Organization of Family Doctors. Now you can’t get the acronym WONCA out of the World Organization of Family Doctors. The official name of WONCA I probably cannot recite, but I will try, and that is the World Organization of National Colleges and Academies. So that’s where you get the WONCA. But then it goes on from there, National Colleges and Academies of General and Family Practice or something like that. And obviously we can look that up. So when I am talking about WONCA the current brand really is the World Organization of Family Doctors even though the acronym doesn’t add up. And WONCA is the world body to which approximately 100 organizations around the world, family medicine and general practice organizations around the world now belong. So it is our international family medicine body. The analogue in the [    ] special community would be the American Medical Association which has in its membership all specialties, has as its analogue the World Medical Association based in France, just outside of Geneva, Switzerland. And other specialty societies in the United States have analogues in their respective specialties. For example, the American College of Obstetricians and Gynecologists has a world body called FEGA or the Federated International Gynecological…I don’t know what it is. But we have similar groups across the spectrum of American medicine. WONCA was created approximately thirty years ago. The Academy was one of the founding members when it was still the American Academy of General Practice. So the AAFP was one of the founding members of WONCA. And one of the early presidents of WONCA was an Academy past president, Dr. Edward Kowalewski, now deceased. We have since Dr. Kowalewski another Academy member who was president of WONCA, Dr. Bob Higgins, who also is a past president of the AAFP and Dr. Higgins is still alive and would be an excellent source of information about World WONCA for this archives in addition to his contributions as an Academy president. So World WONCA is a very large organization in terms of its member nations and a very tiny organization in terms of its infrastructure. It is based in a secretariat in Singapore. And in that secretariat there is a CEO who is a family physician, Dr. Alfred Loh. And Alfred Loh is about two-thirds time perhaps as the CEO and he maintains still a practice in Singapore. There are two full-time people and that’s it. A very competent administrator named Yvonne Chung and a very competent assistant and finance person named Julian (I forget his last name). So World WONCA is our go-to world body but it is a very small operation. It runs almost entirely on the dues it receives from member nations. And the Academy is the largest member nation of WONCA and the one which contributes the most dues to world WONCA. And the work gets done by World WONCA through those dues but via the contributions and the volunteer efforts of family doctors and general practitioners and all the member nations. And it serves a variety of purposes, probably the greatest is to assist in the development of our specialty around the world, promote the public health of patients through our specialty of family medicine, as we would call it in the United States, and general practice in the UK, the Netherlands and some of the other parts of the world. The membership of World WONCA  therefore is from a huge organization like the Academy down to tiny, tiny little organizations in South America and Europe - some of the European organizations perhaps having only thirty or forty members, like Malta. Or in South America some of the new Colleges of Family Medicine in those countries have 100 or 200 members. So we are very involved in World WONCA.\n\nWorld WONCA for the last many years has had a world conference every three years. The World Conference of WONCA in 1980 was hosted by the AAFP and was held in New Orleans. In 1988 the AAFP hosted a WONCA regional meeting. And by regional it was primarily for the North American region that is Canada, the United States. But it also attracted people around the world but it was on a much smaller scale than the meeting in New Orleans in 1980. So there hadn’t been a world meeting in the United States from 1980 until one which we have now completed in 2004 in Orlando. In the interim there was one other World WONCA meeting in North America, that was in Vancouver, British Columbia, hosted by the College of Family Physicians in Canada. And that occurred in, I believe, 1992.\n\nTypically how many participants and countries are usually involved in these meetings? \n\nWorld WONCA has regional meetings in their years in between the triennial world meetings. And those meetings can draw anywhere from several hundred to in the case of the European regional meeting draws 2,000 or 3,000. The world meeting has ranged anywhere from 2,000 to - in the case of the Academy’s hosting of World WONCA in ‘04 in Orlando it’s a little harder to judge because it was in conjunction with the AAFP Scientific Assembly. So the combined registration by physicians was around 6,000. And maybe 2,000 or 2500 were specifically identified as WONCA. But there were Americans who came to that meeting because it was WONCA who registered, if you will, on the Academy’s side of the ledger rather than on the WONCA side. So really I think it’s important to know that the American Academy of Family Physicians has made a contribution to World WONCA by its leaders, by its elected leaders that I mentioned, its staff efforts in the current era primarily by me. And preceding me, Dr. Tom Stern was involved to a degree in WONCA. He was never an officer but he was part of attending, at least, and organizing the meetings in the United States.  \n\nWe started thinking in the mid ‘90s that was time for the AAFP to step up and host a World WONCA meeting again. And at the staff level discussions were started with the meetings planning people and the membership people and my people about how we would do that and came to a decision that we would work through our Commission of Education who liked the idea and its Subcommittee on International Family Medicine. And a proposal was prepared for the Board of Directors which had a fiscal note and all and that was presented to the Board of Directors in 1997 and it was approved that we should go forward. Going forward doesn’t mean we can do it. Going forward means that we have approval of the Board to put together a bid to be the host because nations like to be the host of WONCA and there is a bidding process. The bidding process occurred at the world meeting in Dublin, Ireland in the summer of 1998. So in 1998 the previously Board-approved bid about what we would offer, what we would charge, what we would give to WONCA, because World WONCA takes a substantial levee from these meetings - we presented that bid. The primary bidder from the membership side presenter was Dr. Neil Brooks, then the Academy president, and Sondra Biggs and I and others, Mickey Schaefer, were there in Ireland to assist with that bid. We got the bid. That meant we really had to start working because that was in 1998. There would be another world meeting in 2001 in Durban, South Africa and ours was going to be in October of 2004 in Orlando, Florida. So with the successful bid process under our proverbial belts we then planned for the next six years as to how we were going to pull this meeting off. And we started very gently with sort of save the date messages because we did not want to in the years between 1998 and 2001 do anything as Americans to overshadow the world meeting that was going to occur in 2001 in Durban, South Africa. However, we did attend multiple world meetings. I was a consultant during that period and actually prior to that period to the WONCA planning meeting for Durban in South Africa. So I was back-and-forth to South Africa two or three times in that period. And then helping the South Africans plan their meeting and then in 2001 we had a very substantial Academy presence. We had big booths to market in 2004. And for the first time we had an international Academy marketing booth where we marketed Academy products and services. That has grown substantially since that first effort in 2001. Then following the WONCA World meeting in 2001 in South Africa we really ratcheted up our marketing and dispatched marketing teams to the WONCA regional meetings around the world up to and including in the summer of 2004 in Amsterdam which was the last regional meeting of WONCA where we marketed our meeting in the fall. We did a whole lot of promotion and had a great time doing it. We got very good visibility for the United States. But something totally beyond our control had happened, September 11 occurred in 2001. And immediately after that we had great outpouring of world support for America because we had been hit by terrorists and things looked very, very good for people wanting to come to America. Then two things happened. One is because of September 11 our visa procedures and our borders tightened very substantially and it became very, very hard for people from some nations to get visas. And we could see that coming and started planning for that. But in the twelve to eighteen months prior to October of 2004, even though we had set up a whole mechanism working with the State Department and others to inform U.S. consulates all over the world that this is a legitimate meeting, we got all kinds of communications from doctors around the world, particularly places like the Philippines, Nigeria, the Middle East who were unable to get their visas to come to the United States. And that we could tell was going to have a real dampening effect on attendance. It also had a dampening effect on world opinion of us because there were so many stories about people wanting to come here being treated real rudely and sort of being considered a terrorist when they were in fact wonderful family doctors. So the double whammy against us from world politics was the difficulty in getting visas for these folks from around the world - in from such countries as China which we had no acrimony at all. The Chinese said they were unable to get visas and they were going to send a whole delegation. The other thing, of course, was the world opinion of the United States changed so dramatically after we invaded Iraq. In the run-up to the invasion of Iraq the bad will was starting. But when we invaded Iraq and from that time in the spring of ‘03 to the fall of ‘04 things went from bad to worse. And even when we would go and promote World WONCA in particularly western Europe, Europeans would come by our booths in great numbers to say we will not come to your country until there is regime change in your country, which is the regime change we were seeking in Iraq. So that hurt us pretty bad and the attendance wasn’t as good as it could have been by a long shot. The meeting was still excellent. But again one of the fallouts of that was that a whole lot of authors who had had their manuscripts accepted, their abstracts accepted to speak at the meeting, no-showed. So even though they had applied to give a talk or a poster or a lecture or a symposium, and there were three or four people on a given paper to present, in some cases none of the presenters came and in some cases only one of the presenters came. And partly it was these things I have mentioned - the difficulty in visa, the hassle even if they could get a visa, which was pretty easy from eastern Europe, but the hassle they had to go through, mostly it was the antagonism to the United States of America at that period of time. The meeting went off very, very well. Our president at that time was Dr. Michael Fleming. Michael Fleming represented himself as our president both in the WONCA world meeting and the Academy meeting. So he was running back-and-forth in the convention hall. Michael Chamberlain of our staff hustled him back-and-forth in a golf cart so he could be in all places at once. And we got very good reports from the meeting. And we were glad we did it and we were glad we made a contribution. We just wish it could have been more successful from an attendance and a financial point-of-view. We then prepared, and almost all the credit of this goes to Sondra Biggs - Sondra and her staff prepared reading books on all elements of how to put on a huge world meeting. And those have been provided to the College in Singapore who is hosting the next triennial World WONCA meeting in July of ‘07 as well as to the College in Mexico who are hosting the 2010 triennial meeting of WONCA in Cancun in the spring or summer of 2010.  \n\nI want to shift gears a little bit and talk about some of your personal reminiscences, your memories of your involvement in past WONCA meetings. \n\nI could categorize remembrances into those which are sort of official in the development of family medicine around the world or I could categorize them as fun things on a personal level that may not have great relevance to the Academy. And I guess I will focus on that and we will do some more formal things at another time.\n\nI assumed kind of a tiny role with the Academy in nurturing WONCA, except for some of the elected leaders which I mentioned. But from a staff perspective, when I took over the role of Vice President for Education and Science I took over a role of kind of being kind of a staff coordinator of our work with World WONCA. The first World WONCA meeting to which I was privileged to go was in London in 1986. At that time we had several little meetings between Americans and the British, the Royal College of General Practitioners, and others. But one thing that I very specifically remember is that my wife Ruth and I were at the huge reception and we were in a receiving line for the Queen of England and Prince Phillip. And this is, of course, hundreds and hundreds, if not thousands, of people in a big room. Maybe we got into some kind of privileged position but the Prince and the Queen were walking towards us and there are people on both sides of sort of a corridor and she is coming by and greeting and shaking hands with everybody. And just before the Queen of England got to Ruth and I in this line, I was looked across and facing me on the other side of this kind of corridor and the guy looking at me looked a little bit like me. He was blond guy whose name was Ostergaard. I kind of got distracted from the Queen of England coming to me by making conversation with this other guy named Ostergaard. He was Iver Ostergaard from Denmark. And we sort of got to know each other standing right there and then the Queen walked by and we of course shook hands with and she was gracious and greeted us. Maybe we didn’t shake hands with her. Maybe that was forbidden. Maybe it was just a greeting. Anyway, she was gracious. So that’s just a little anecdote from my first WONCA meeting in London. At that time I didn’t really attend any of the regional meetings that occur between world meetings. So my next WONCA effort at that time was attending the World WONCA meeting in Jerusalem in 1989. And that was a particularly interesting meeting because Jerusalem is probably the most interesting city on earth to me because of all the obvious things - the crossroads of three major religions as well as other minor offshoot of all of them as well as a crossroads of politics. 1989 isn’t actually all that long after 1967 when the current boundaries of Israel were drawn. So it was fascinating. And Ruth and I took all three kids to Jerusalem. So yes, we did do the meetings. And I got involved, as I usually do, with some side meetings and ended up getting the American Academy involved in a variety of things there. But the thing I really remember is how much we stood out as the family of five of us. Because any time I wasn’t in meetings we would go somewhere, go to dinner, and we were very obvious. And even taxi drivers who we would go with by the middle of the week we were there would say oh, I saw you in some restaurant or someplace because it wasn’t very common to have that. I remember on a Friday walking through the Old City of Jerusalem in the Arabic quarter when I was extremely quiet because all the Muslim folks were in prayers and the only sound was the clomp, clomp, clomp of Israeli soldiers with machine guns walking by. And then, of course, when prayers got out, in the mosque, then the streets were absolutely flooded. Also, while I was working at the meetings and going to them, Ruth and the kids would take tours throughout Israel because Jerusalem is the wonderful jumping off point to go up to Galilee or over to Jericho or wherever. I also found the need for a family doctor. And even to this day Dr. Slcmo Monakindem is my Israeli family doctor because I got a terrible bacterial conjunctivitis and had to find somebody who could help me. And Dr. Monakindem gave me Chloramphenicol and that was not something I had ever used because it’s banned, it’s so powerful, and causes birth defects. But it sure took care of my eye infection. So those are some little memories of Jerusalem. I will just add one more on a personal note. My whole family was in the pool swimming at the Hilton in Jerusalem and Dr. Reg Perkin, it was the first time I met Dr. Reg Perkin who became the executive vice president of the College of Family Physicians of Canada and was the coordinator of the meeting in 1992 in Vancouver, that was the next world meeting. Maybe that wasn’t the first time I met him, but the first time he met my family. And we’ve been very, very good friends ever since. And Dr. Perkin has just been named an honorary member of the AAFP.\n\nGoing on then from ‘89 to ‘92 in Vancouver, the next world meeting was in Vancouver, BC. And one personal note there that I’ll share, and that was that I had opportunity to meet many times a childhood classmate and very close friend of Fidel Castro, a guy named Dr. Cosme Ordóñez. And Cosme speaks perfect English. And, of course, with the difficulties between the United States and Cuba, we could to some degree come together around issues of family medicine and have common ground. But nevertheless, he would always accuse me of being a capitalist and that the AAFP was too rich and what we do doesn’t make any sense for the poor countries like Cuba. But I remember very well going to lunch with this Cuban friend of Fidel (they actually were elementary school classmates and have been fast friends ever since). We went to lunch in a fancy restaurant and when I offered to pay, as the capitalist, he as the communist did not refuse whatsoever and actually ordered his dishes in abundance because the capitalist was going to pay for the communist. So he didn’t seem to have a philosophical aversion to capitalism at that particular lunch. Of interest is I saw just fleetingly Dr. Ordóñez just two months ago at a WONCA South American regional meeting in Buenos Aires. But I had to leave just as he was getting there and we never had a chance to visit again. But I asked others about him and he still is one of the closest advisers to Fidel Castro.  \n\nThe next world meeting was in Hong Kong in 1995. And again had the opportunity to take all of my family members to Hong Kong. It was at that meeting where our president at that time, Dr. Bill Coleman, got me heavily involved as an individual and as an Academy member representative of World WONCA. So from the Academy point of view there, at that time, in 1995, there was a real need to integrate Europe more into WONCA. There was a separate organization in Europe called (I forgot the letters), but it was SIMG. And that organization needed to be brought into WONCA and disband and become WONCA Europe. And there was a world task force formed and I was asked to chair that even though I didn’t know many of these people. So I became chair of this sort of WONCA reorganization task force as put forward by Dr. Bill Coleman and since then I have been extremely involved in WONCA. And that assignment led me to other consulting work with WONCA and then to my current capacities. And my current capacities include having done that task force in ‘95, ‘96, ‘97 and then being a consultant to World WONCA for Organizational Development in ‘97, ‘98, ‘99. And then, of course, as chair of the WONCA 2004 Host Organizing Committee doing all of the communications and leadership for getting the world meeting together in Orlando in 2004. But back to Hong Kong. The family note there was that we made that an opportunity to show our family four Chinas. And the four Chinas at that time were four Chinas because it was before the return of Hong Kong to the People’s Republic of China which occurred in 1997. So in ‘95 there were four Chinas. And we flew first to Taipei, Taiwan and spent a few days seeing the island of Formosa and learning a bit about the flight from mainland China of Chiang Kai-shek at the time of the Mao Tse Tung revolution. And then went on to Hong Kong for the World WONCA meeting. And while I was at meetings and the usual type activity, the family did a variety of things in Hong Kong. But we took two different side trips from Hong Kong on two days we had off - we stayed a little extra. And one was to Macau, Portuguese China, which since has also been returned to mainland China. We went there by a ferryboat or hydrofoil. And we also took a day trip from Hong Kong to mainland China, to the People’s Republic of China, to Canton, or as they call it Guangzhou. And the whole family had their first experience in a communist country and their first experience in mainland China. And that was very interesting because the children were small. Rachel was probably eight or so, the youngest. And we had to line up by name to get visas because we had no visas to get into the People’s Republic of China. But they were very interested in our American dollars just like Cosme from Cuba was three years earlier. So we had to get into kind of rigid format and take a train up to Canton. And then I went on tours of Canton and got to see how people lived in that setting. So that was sort of a personal highlight of WONCA of 1995 in Hong Kong, that the whole family got to see four Chinas - Taiwan, Macau, Hong Kong and the People’s Republic of China.\n\nWe just talked about the 1995 World WONCA meeting, the triennial meeting in Hong Kong. And I mentioned at that time I was really thrust into a major World WONCA role. But that also then picks up where we talked about earlier in the tape about WONCA. Because it was at that time that back at the Academy, back at the ranch here in ‘95, ‘96, ‘97, we started thinking about preparing and getting the Board of Directors on board with having a World WONCA meeting in the United States in 2004. So in 1998 we had the World WONCA meeting in Dublin. And because I was working so closely then with WONCA leadership, I was at the World WONCA Council Meeting for the first time which was in Killarney, Ireland, in southwest Ireland. And in Killarney worked with the WONCA World Executive Committee and WONCA World Council. And that is where the bid occurred. However, because it occurred right in June, at the time of the AMA meeting, I had to leave Killarney, rent a car, fly to Cork, Ireland and fly to London Heathrow and take a morning flight from Heathrow  at 8:00 am and got to Chicago at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471/transcript/81506/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the same morning and went right into coordinating the Academy activities at the AMA meeting in Chicago for I think two days. And got right back on a plane and flew back to Dublin. Because by that time the meetings had moved from Killarney into Dublin. So I actually missed the presentation of the bid because I had to leave to go to Chicago. So when the bid for us to host WONCA 2004 in Orlando was presented by Dr. Neil Brooks and Sondra and Mickey I was already in Chicago. So I got a phone call in Chicago saying we got the bid. And then after I did my AMA thing I got back on a plane and went to Dublin and finished up the World meeting in Dublin. Ruth was with me then but no kids. Ruth has been with me at all the meetings. But at ‘86 in London we had no kids, in ‘89 at Jerusalem all the kids, ‘92 in Vancouver no kids, ‘95 in Hong Kong all the kids, ‘98 in Dublin no kids. And then we were really heavy into preparing for WONCA 2004, although not promoting in the time between ‘98 and 2001 in Durban. In a meeting in Durban I had taken my son Josh with me to one of the planning meetings in Durban and we got to go on safaris and stuff in ‘99 or 2000. And then when the actual meeting occurred in 2001, Ruth and I went early for all of the pre-meetings as we were now very much involved. And then my youngest daughter Rachel got on a plane and flew all by herself to Durban via Johannesburg - which the flight is like eighteen hours non-stop from New York. Rachel joined us there and then we went on a safari after the meetings were over. And on that safari it was Ruth and Rachel and I, Mickey Schaefer and Sondra Biggs and Roger Sherwood and Anne Sherwood. So we took advantage of the work opportunities to take a few days and so some things that we were fortunate to be able to do in a place like the Province of Kazala in eastern South Africa.\n\nSo from Dublin to Durban we were working on Orlando but not very visibly. But then from Durban to Orlando in 2001 to 2004 we ratcheted up substantially and attended every kind of regional meeting or opportunity for promotion we could. And that included Amsterdam as I mentioned before. And somewhere in that six-year period other countries included Australia and Malaysia and Borneo. And second meeting in Malaysia and Borneo. And this may be another discussion, but at that time two of the three kids came with Ruth and I. We flew to Singapore and then flew from there to Kuching in Malaysia on the island of Borneo. Borneo is divided into Malaysia, Indonesia and the Sulfan at Dubrana (?). And we were in the Malaysian portion. And it was a WONCA world meeting and they are very active in World WONCA. So I was consulting so I got my way paid. But also we got to promote a little bit the possibility of World WONCA in 2004. And while there I arranged the schedule to have one day off. And during that one day we, along with part of Michael Bolin’s family from Ireland, went way deep into the jungle of Borneo to places that you could never have imagined you would ever go. And we went by a minibus maybe three or four hours into a jungle and then came to a stream and go in a long boat with some Ebon people. And the Ebon people are scantily dressed. They are headhunters or were headhunters; they don’t hunt heads anymore. But the Ebon guy who paddled our long boat had tattoos all over including ring tattoos on his neck. This guy was probably 70 years old. And from a former time ring tattoos symbolized the number of heads he personally had taken during the headhunter times. So we went deep into the jungle on this long boat and to a long house. And the people lived in a great big, long, long house and it was divided into compartments in which each family lived. And then in the front, all the way the length of the long house, there was communal living and cooking space and washing space. And down at one end there was still a shrunken head hanging above a pot and the pot was smoking. And apparently this head is always there and is always receiving the smoke rafting up from the ashes as some kind of a warding off of evil spirits for the future. So no, they don’t take heads anymore and no, we didn’t see many heads. But there was one head which was in active use in some sort of spiritual significance. Interestingly in that regard, many of the Ebon are actually Christians because they had been colonized by missionaries and many of them had converted. So it was sort of a strange combination, as we have seen in other cultures, of old ways and western Christian ways. So another incredible opportunity given me by the Academy to hopefully make a bit of a contribution but also see part of the world that most people never even read about - or even if they read about, can’t imagine having been there. That is just one of the locations to which we went to promote WONCA 2004.\n\nAnd that kind of takes us up to what we talked about earlier in the day, the meeting of WONCA 2004, and now kind of the debriefing from 2004 to 2007 which is where the world meeting is in the summer of 2007 in Singapore and our official representative to that meeting will be our current president, Dr. Rick Kellerman. And of course I will be there as well.\n\n\n\nThe first child Heidi was born when I was an intern in Duluth. The second child Joshua was born in our first stint here in Kansas City. Heidi has a Master’s in Developmental Psych, Josh has a Master’s in Anthropology and works at the Field Museum in Chicago. But he is actually a writer at heart and has spent time at the Baseball Hall of Fame and has just finished his first novel, his day job being soft money with the Field Museum as an anthropologist. Rachel, the third, was born in our second stint here. Josh is, I think, 29 and Rachel is 24. She was born here in Olathe just after we moved back. And she is currently a missionary in Amsterdam in the red light district. She spent a year right out of college working in Amsterdam at a Christian youth hostel called Shelter City, which truly was a shelter right in the middle of all of the drugs and other terrible things in the city of Amsterdam. And they had a shelter for kids from all over the world to go and stay at the youth hostel without drugs and alcohol and with men and women in separate parts of the dormitory setting. But now she is back in Amsterdam with another group called Youth With A Mission and working with a group of people who are doing outreach to the prostitutes in the red light district and to those who come by who participate with the prostitutes. They just strike up conversations. This has only been going on for a month and I’ve not been to Amsterdam since she got there, so I don’t have much information. But it’s reaching out to people who are in difficult life situations and hopefully pointing out that there is a better way to live and that there is an opportunity to learn some other skills as well and basically to reach out to people who are hurting in a variety of ways. Now all three of those kids went to a Christian college called Wheaton College in Wheaton, Illinois. And that as well as some of our background was clearly formative to encourage them to make a contribution to society and to people who have need. And all three of the kids have traveled with Ruth and I in many parts of the world and that’s been very formative. And I guess we are living with the results of that just a little bit because I’m not sure that any of the kids will ever come back to Kansas and I suspect that some of them will live internationally at various times during their careers. Some of the kids have been with us in such places as South Africa and the jungles of Borneo and the halls of the World Health Organization in Geneva. So basically everything from Geneva to Borneo, they’ve been part of our experience as we have done WONCA work, Academy work, our own outreach work. We brought the whole family, for example, several years ago to spend a couple of weeks with friends of ours who are missionaries and educators in Ecuador. So, again, they are the product of their experience with us and my parents as medical missionaries and our time here at the Academy. They grew up with the Academy. They know many of the leaders and believe in what we are doing.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280471#t=600.0,3503.34893"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280475","type":"Canvas","label":{"en":["Media File 2 of 3 - Ostergaard_Daniel_Pt1_06_a.wav"]},"duration":2001.53208,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280475/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280475/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/280/475/original/Ostergaard_Daniel_Pt1_06_a.wav?1751474661","type":"Audio","format":"audio/wav","duration":2001.53208,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280475","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280474","type":"Canvas","label":{"en":["Media File 3 of 3 - Ostergaard_Daniel_Pt1_06_b.wav"]},"duration":1887.14397,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280474/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280474/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/280/474/original/Ostergaard_Daniel_Pt1_06_b.wav?1751474655","type":"Audio","format":"audio/wav","duration":1887.14397,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/152162/file/280474","metadata":[]}]}],"annotations":[]}]}