WALLA WALLA - Dr. Brad Titus practices cardiovascular medicine in Walla Walla and does so with all the skills his education offers and the considerable technology available at his fingertips.
And Dr. Brad Titus practices medicine across the world, in the Republic of Rwanda, where his tools include worming medicine and childhood vaccines.
These are worlds apart in nearly every way, but Titus is attempting the same thing in both cases - to raise and equalize the standard of health care in each place.
There also is the ultimate goal on both sides of the ocean, which is to teach people to take care of themselves.
Titus, who has practiced since 1990, has been at Walla Walla General Hospital for a year as part of the Adventist Health network.
His mission here as an interventional cardiologist is twofold: Help Walla Wallans prevent the huge health losses that often come from heart disease and bring the hospital's standard of heart care up to the standard larger facilities in the network have obtained.
For that, Titus leads his staff crew in performing emergency angioplasty and stent procedures, which prior to his arrival required patients to travel an hour to the nearest hospital able to perform those procedures, said WWGH Marketing Director Kristi Spurgeon Johnson.
Heart attack remains a leading cause of death in this nation. Heart disease due to lifestyle choices and genetics is at the top of the list of local killers, too, Titus said.
For victims experiencing an attack due to clogged arteries, quick treatment is vital.
"For the heart attack patient, from an artery that is 100 percent blocked, we must open the vessel. The heart is being damaged minute by minute," he said.
Outcomes improve significantly when a cardiologist can get through the blockage with a balloon in the artery within 90 minutes of onset of the heart attack and put in a tube - or stent - to keep the passage clear, Titus explained. "The clock begins ticking the moment a patient feels discomfort and with these new procedures we save precious time and, in many cases, eliminate the need to transport patients an hour or longer to cardiac facilities."
The procedure is nearly always successful and most people know this, he added. Interventional cardiology, a proactive approach to treating someone having an attack, gained momentum in the 1990s and Titus was among the nation's first to have full, dedicated training in the discipline, he noted.
Getting that education into a Walla Walla hospital becomes more vital the more society ignores the preventive medicines of appropriate nutrition, exercise and staying away from risky behaviors such as smoking.
Conversation about changing the picture of health care in the U.S. focuses on insurance reform at a time it might be better to look at personal health responsibility, Titus said.
It's a significantly different story in his other practice.
After becoming interested in overseas ministries through mission trips to Guatemala, Titus turned his attention to work being done by Africa New Life Ministries, he said.
The organization is based in Rwanda, a country perhaps known for the 1994 genocide that killed 500,000 to 1 million people in the course of 100 days.
According to Africa New Life, between 250,000 and 500,000 women were raped during that time, unleashing the AIDS epidemic in Rwanda. The twin tragedies resulted in more than 600,000 orphans in Rwanda by 2001.
Even as the country began rebuilding, what Titus found on his first visit there in 2009 was heartbreaking, he recalled: children dying from brain abscesses that began in their teeth or emaciated from masses of worms in their guts.
Changing things in Rwanda requires a long-term plan "to raise up people to take care of themselves," the cardiologist said. That means education, sources of clean water, orphanages and a permanent medical clinic.
It would astound Americans to see how the most basic of medical needs go unmet, Titus said. "When we go and do some of the clinics, some are just coming in for small complaints. They need antacids or Tylenol. That we all have at home here."
One patient arrived with the worst case of gingivitis Titus had ever seen. "I gave him dental floss and taught him how to se it."
There are some answers, starting with a permanent medical clinic that can offer services not available to Rwandans, such as an ambulatory surgical center, cardiac and oncology services. Which, hopefully, would encourage the region's residents to seek out that sort of treatment, he added.
The concept is a 6,000-square-foot building in the nation's capital of Kigali, which boasts a population of nearly 1 million people. Locating it there would bring in patients who could afford to pay for care, keeping such a clinic sustained, Titus explained. "You can't fundraise for your institution forever. Maybe a year or two …"
With a facility in place, it is the hope that Rwanda could attract native and foreign doctors. There is no physician training in the country and those seeking it must go elsewhere, he said.
"Most African doctors who have really good training, they don't go back. The pay range for a doctor in Rwanda is $10,000 to $20,000 a year. They go abroad and they see economic opportunity."
By training in their home country, some of the doctor drain should be diverted toward Rwanda, Titus said.
Once a clinic is established, the next step would be to build a hospital. Rwandans deserve better than what they get now - "a group of American doctors coming once or twice a year," he said
The immediate goal is to raise $500,000 for the clinic's building and infrastructure. Titus has gathered a group of supporters who are seeking ways to turn the concept into bricks and windows and roofing materials.
They are considering hosting dragon boat races in the area, for something new to get the attention the cause will need, the physician pointed out.
His vision, in the short version, is similar to what he wants for Walla Walla, Titus said, and that's for people in the African country to have a certain standard of care for everyone.
His plan is to be working feet-on-the-ground in Rwanda as soon as he is done with his American practice. "I've always been the driven one, the one to strive for excellence."
Titus wanted to be a doctor since he was 6 years old, believing it to be a calling from God, he said with a smile. "My parents would buy my brothers model cars for Christmas. They bought me model body parts."
To contact Dr. Brad Titus, email email@example.com. For more information about Africa New Life Ministries, go to www.africanewlife.org.
Sheila Hagar can be reached at firstname.lastname@example.org or 526-8322.