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James Strickler, M.D., '51: Reaching out to refugees

By Laura Jean Whitcomb

After eight years as the dean of Dartmouth Medical School, James Strickler, M.D., decided to retire in 1981 along with his "favorite boss," Dartmouth College President John Kemeny. At a social event to introduce the men's successors to the Upper Valley, partygoers thanked Strickler for saving DMS from financial ruin. Strickler began his reply by noting that the rescue had really been a team effort—until Kemeny interrupted with "Strickler, dammit, take some credit. If you hadn't pulled it off, you know who would have taken the blame!"

Even today, Strickler, an emeritus professor of medicine and of community and family medicine, is modest about his accomplishments. From his office in Strasenburgh Hall, he is quick to mention his collaboration with staff, trustees, alumni, and allies at every stage of his career—as a student, faculty member, dean, nonprofit agency board member, and international humanitarian. But what speaks loudest about his accomplishments as an educator and physician are the photographs that cover his office walls —Strickler with his patients, many of them refugees from troubled countries all over the world.

"Thailand was a watershed experience in our lives," Jim Strickler says. "We worked long hours in an open-sided hospital with a bamboo roof and concrete floor."

It was his military service that sparked Strickler's passion for refugee medicine. After graduating from Mt. Lebanon High School in Pittsburgh, Pa., in 1945—when World War II was still raging in the Pacific— Strickler joined the U.S. Merchant Marine Cadet Corps. (He had hoped to enlist as a naval aviator, but enrollment in that training program was closed at the time.)

By the time he was ready for college, Strickler had roamed around the Caribbean and up and down the coast of South America in the maritime service. He knew he wanted to go to Dartmouth—he had been inspired by John Dickey, who served as the College's president from 1945 to 1970.

"John Dickey took part in the 1945 San Francisco conference that founded the United Nations," says Strickler. "My generation grew up during World War II. We were very attuned to world events, and it was Dickey's work that got me interested in international affairs."

Strickler graduated from Dartmouth College in 1950, from DMS in 1951, and from Cornell University Medical College in 1953. He then did an internship at New York Hospital-Cornell Medical Center in New York City before joining the Navy in 1954 as an independent- duty ship's medical officer. He served during the Korean War in Japan, Okinawa, Taiwan, Hong Kong, and the Philippines, often visiting local clinics and hospitals.

In 1956, Strickler returned to New York Hospital to complete his training in internal medicine and then joined the faculty at Cornell, where he taught physiology and medicine. But in the 1960s, he heard that change was under way at his alma mater—DMS was converting from a two-year school of basic medical science to a full M.D. program. In 1967, he left Cornell to become associate dean for academic affairs and an associate professor of medicine at DMS.

"What got me interested in deaning was an interest in medical education," says Strickler. "I realized that it could be substantially improved. Even the premedical curriculum needed to be redefined." For example, back then Dartmouth mandated a chemistry- zoology major for premeds, which, Strickler feels, "left too few opportunities to study the humanities and social sciences."

Carlton Chapman, M.D., DMS's dean from 1966 to 1973, asked Strickler to head the academic planning committee that developed the M.D. curriculum. "I am especially proud of several curricular innovations that continue to be successful: the Scientific Basis of Medicine course; the Health, Society, and the Physician course; and a second course in pharmacology in the final year," Strickler says. "I also helped Chapman build academic clinical departments at Mary Hitchcock and the VA Hospital and spent a fair amount of time recruiting the first clinical chairs for those departments. It was a fun, exciting, and challenging time."

Building strong academic programs wasn't Strickler's only task; the school needed to develop a financial plan, too, to stabilize its operations after several years of significant expansion. Although Strickler had never seen a medical school budget before, he worked to save DMS with a team that included William Morton, a 1932 Dartmouth College graduate and the president of American Express, and Kemeny, the College's president and a well-known mathematician.

In 1973, Strickler was named dean of DMS. He continued to improve the Medical School's financial situation over his eight-year tenure. One of his strategies—the Brown-Dartmouth Program—is still in existence. By having 20 students in each class spend their first two years at Dartmouth and their last two years at Brown, Strickler saw the program as a way that DMS could increase revenues without increasing expenses. "Dartmouth could handle the preclinical part and Brown had the capacity for the clinical," says Strickler. "It took some selling, but the program was eventually passed by the Trustees and, along with fund-raising and renegotiation with the Hitchcock Clinic, covered the Medical School's $1.2-million annual deficit."

But although Strickler says he was asked to become dean because he understood the School's financial problems, his real joy was developing academic programs. He was a strong supporter of the Department of Community and Family Medicine, which was recently ranked 15th in family medicine in the nation by U.S. News & World Report. He was also responsible for establishing the DMS Board of Overseers; hiring the first fulltime admissions officer; creating the alumni relations office; greatly expanding the development office; and helping to diversify the School by increasing the enrollment of women and minority students and recruiting DMS's first black administrator. In addition, the magazine that is now Dartmouth Medicine was established during his tenure.

Thousands of refugees around the world—including this Khmer mother and her child—have benefited from Jim Strickler's ministrations over the past 20-some years.

"Everything I have been involved in has been a team effort. I may have provided leadership, but I have not done it alone," insists Strickler. "I was in the position of recruiting great people."

Soon, the hard-won financial plan began to pay off. Sponsored research and endowments doubled during Strickler's deanship, and the new alumni relations program helped development attract $30 million in donations—an eye-opening amount in the 1970s. "When I retired in 1981, I told Dartmouth College that the budget would be balanced in three years," says Strickler. "It was balanced in two."

Strickler was a young dean, leaving the post at age 55. Not quite ready for retirement, he asked himself what he really wanted to do. "I enjoyed being a doctor and teaching," he says. "I enjoyed international health." In 1979, he'd traveled to China on a health-study tour. "Mao Tse-tung was dead, but his Communist regime lived on," Strickler says. "People were dying from diseases that could have been prevented by public-health programs and primary care."

It was this trip that came to mind as Strickler formulated his postdeanship plans. He and his wife, Pegge, signed on as volunteers with the International Rescue Committee (IRC), a New York-based agency that assists refugees and victims of war around the globe, and went to Thailand for a six-month assignment. Jim Strickler was a hands-on physician in the pediatrics ward of Khao-I-Dang, Thailand's largest refugee camp for Cambodians. Pegge, who was the children's librarian at the Howe Library in Hanover, taught English. Despite facilities that were rudimentary at best, and a high mortality rate among the refugees, the Stricklers fell in love with Thailand.

"Thailand was a watershed experience in our lives," Jim Strickler says. "We worked long hours in an open-sided hospital with a bamboo roof and concrete floor. There was no air conditioning and lots of flies. There were serious illnesses; sometimes the problems were overwhelming. I remember sitting down at the end of one day, completely exhausted, and saying to Pegge, 'I had a hell of a hard day today, but I saved that kid's life.' It felt good to be a doctor."

After their return to Hanover in 1982, Strickler spent the majority of his time in patient care and teaching. He practiced geriatrics at DHMC (taking the geriatrics certifying exam just after the specialty was formally established and attaining board certi- fication when he was the age of some geriatric patients), taught part-time for the Department of Community and Family Medicine, and led the planning for DHMC's off-site Community Health Center. In addition, the trip to Thailand had reignited Strickler's interest in international health. He developed a "parallel track in refugee medicine," mainly through ongoing work for the IRC. He joined the IRC board in 1982 and set about making changes.

At that time, "refugee health programs were run by highly motivated volunteers, but they needed a structure led by health professionals," says Strickler who chaired the IRC's executive committee from 1990 to 1999 and now cochairs its board. He helped to establish a health unit for the organization to provide medical care to refugees and conflict-affected populations, and he helped to recruit the IRC's first full-time staff physician. Today, with programs in 30-some countries and territories throughout Africa, Asia, and Europe, the health unit is one of the IRC's most important activities.

In 1999, at the end of the war in the Balkans, Strickler visited Kosovar refugees in Albania and Macedonia—his 25th overseas trip for the IRC. Upon his return home, he and several DMS colleagues, including Dean Seibert, M.D., conceived of the Dartmouth-Kosova Project. This collaboration has helped the Kosovars rebuild their medical school and hospital, which had been devastated by Serbian hostilities. The program involves regular exchanges of faculty and students, thanks to the generosity of an anonymous donor.

Dressed in a plaid shirt, khaki pants, and a multi-pocketed, darkblue field vest, Strickler looks like he is ready for his next trip. In fact, he's headed for Europe later this fall—a vacation in Spain and England, as well as another visit to Kosova. On his docket for 2004 is a trip to Cambodia to see family and one to Thailand to evaluate the IRC's border programs for Burmese refugees.

These travels give Strickler a real-world rather than a boardroom perspective on his work. "It's not the same satisfaction as being a hands-on physician providing patient care," he admits, "but I take a lot of pride in the changes taking place. I couldn't have done this if I wasn't a board member."

With a wide range of talents, Strickler could have been anything he wanted: teacher, finance guru, leader. "Why medical school? I had a lot of trouble with this question when applying to medical schools," he says. "It wasn't until later that it hit me. I had a sister who died from a congenital anomaly when I was four years old. I know, in retrospect, that her death was my primary incentive. I wanted to help people.

"Everything I have done," he concludes, "clinical, educational, or international—has been a derivative of that. Whether it's with the health unit of the IRC or developing academic programs at DMS, the essential motivation is the same: reaching out in a constructive way to help others."

Freelance writer Laura Jean Whitcomb, formerly a writer and editor in Dartmouth-Hitchcock Medical Center's Office of Public Affairs, has written extensively about health care.

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

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