Duke's Global Health Institute: Noble idea, troubling execution. Exporting education programs with no faculty oversight

✔✔✔✔ The Duke Global Health Institute is a noble idea of the first order, a part of Duke University that's only five years old but truly can be said to be doing God's work on earth, and an enigma because its leadership is refusing to discuss with Fact Checker some very serious, emerging issues.

One of the key issues: whether academic programs -- including those leading to a Duke degree -- have been approved by the Institute faculty and the Academic Council as provided in the university by-laws, a process that insures viability and integrity and rigor. Our faculty source said no.

From one e-mail: "It's unbelievable. I just heard through the grapevine that global health is preparing to hire faculty to be full-time in Kunshan, and we regular faculty have not even voted on whether we want to pursue programs there! This endeavor will be a disaster."

We will return to this issue of governance, which may well come up in Friday's meeting of Global Health faculty, in a few moments. We begin the body of our essay by turning to the enigma.

✔✔ Our interest was piqued when a faculty member in the Institute who wishes to remain anonymous provided FC with some disturbing information which we will detail. After initial study and a multitude of questions for our source, we approached Dr. Michael Merson, the institute's director (who is also sitting in as the university's interim vice president for global strategy) via e-mail, laying out our concerns and requesting an interview. We told him that we not only wanted to gain his perspective on any controversy -- but welcomed his telling us about the Institute's good work.

We regret very much having to report to Loyal Readers that we were treated rudely: e-mail after e-mail and phone call after phone call, and Merson never responded. We finally informed him of our policy, and told him we would be writing about this failure, to no avail. We even set back the date for this essay, hoping that when Merson returned in mid-week from a trip he would speak to us. No dice.

✔✔ The Institute was founded in 2006 with seed money from Duke University and its separately incorporated and well financed Health System. The basic idea is simple:

"The 20th century was a century of spectacular medicine – and equally spectacular failures to distribute health and health care fairly across the globe."

"Our aim is to become a world-recognized authority in global health and to make significant contributions to the prevention and treatment of health problems, thereby reducing health disparities in vulnerable and underserved populations around the world."

The Institute has grown like wild-fire. Two years ago it had 60 students in its various academic programs. Last year it had 120, and in the semester about to start, the Institute expects far more.

It has 42 faculty -- with an amazing 10 searches underway for additional appointments. And that's not counting 48 faculty shared with other Duke divisions. (We believe the faculty totals are correct; we wish we could have confirmed them with Dr. Merson or with Duke PR which also ignored a request.)

The amount of money involved in the Institute is not revealed in its reports, but we know that since its inception, the number of grants has grown from 2 to 14 to 30 to 34 to 55.

✔✔ We told Dr. Merson that we were troubled by the financial pie graphic in his 2011 annual report, which shows substantial money flowing into administration and allied activities, at the expense of education, research and other field work.

Some specifics;

Finance and administration is swallowing 20 percent of the Institute's budget.

The top-heavy Office of the Director another 16 percent.

And PR -- identified as communications -- another 7 percent.

Total so far, 43 percent.

And in addition to allocations for education (28 percent) and research (19 percent) which goes on all over the world, we were curious about another 11 percent listed only as "international operations." Another administrative cost perhaps?

The Institute has 120 active global health research projects in 28 countries. Students ran 74 projects in 20 different countries. We wanted to know about the philosophy of operating thin in so many places -- versus an intensive, more thorough involvement in a few.

✔✔ And now the academic programs of the Institute. Here are the programs we have been able to discover:

"In fall 2010, DGHI welcomed 24 individuals from Uganda, India, Kenya, Nigeria and the United States into the second cohort of the Master of Science in Global Health. Also in 2010, DGHI celebrated the first two students ... to successfully defend their thesis and complete the program. The future of the program is equally bright, as DGHI received a record number of applications for the third cohort who will be welcomed in
fall 2011.

"The Duke Global Health Institute has launched its first program targeting Duke doctoral students interested in pursuing global health research in tandem with their primary discipline. Beginning in fall 2011, the Global Health Doctoral Scholars Program aims to foster dynamic intellectual exchange between Duke doctoral students and DGHI faculty.... The program, which requires a minimum commitment of nine months, enables students to work on a global health project with a DGHI faculty mentor, develop a global health dissertation and become involved in the DGHI’s growing community."

"DGHI is training the next generation of global health leaders, whether they are in Durham, Moshi, Beijing or elsewhere in the world. Education programs range in level and focus, from the popular undergraduate global health certificate to the training of medical professionals in Rwanda."

"Faculty from Duke, UNC-CH and NC State are working together within the Triangle Global Health Consortium on a new graduate course dedicated to the burgeoning
field of One Health."

✔ And most of all Kunshan.

As Loyal Readers know, the Fuqua Business School has taken the lead in putting forth large-scale degree granting programs in this Chinese backwater, with both proposals so far being shot down by the faculty on June 1. Presumably, although there is no confirmation, Fuqua's new dean Bill Boulding is consulting with his faculty about creating alternative proposals.

While Fuqua garnered the headlines, the Global Health Institute was also proposing a degree program for Kunshan.

Our faculty source: "As far as I know, the global health faculty has not formally approved any academic programs in Kunshan. Participation in Kunshan never came up for a formal faculty vote. No faculty committees have played a role in creating specific Kunshan programs, or reviewing them for rigor and content. As far as I can tell, the global health programs submitted to the Chinese government for Kunshan were developed mainly by a non-academic Associate Director of Education who lists no significant training in global health or higher education on the global health website."

A Fact Checker review of transcripts of the Academic Council meetings uncovered no discussion of the Global Health proposal, which must clear the Council before beginning.

Make no mistake. This is not a turf battle. Our faculty source again: "If Provost Lange approves this model of academic development and standards, I worry about the future of Duke and Kunshan. Universities can only be successful when faculty interests, initiatives, and leadership drive academic programs."

Or put another way in another e-mail: "It's (troubling) to me how the university announces Kunshan programs that have not been approved by professors and university committees. It's Fuqua all over again.

"At Global Health, it's really troubling since the non-academic staff seem to make so many academic program decisions and then present to the faculty for a quick rubber-stamping at meetings, or they make decisions that involve one or two male faculty members (people named, FC omits) who will support whatever the staff wants so that the Director can say that the decision was faculty-based.

'Any other segment of the university would have faculty setting the agenda, not staff who lack substantive academic qualifications in the subject area... The Global Health Institute does have named faculty directors of the undergraduate and graduate programs who just seem to carry out but not make decisions. If the Director involved more faculty, he would not need such a ridiculously large staff or have so much of the budget spent on administration."

✔✔ Beyond the questions surrounding degree granting programs, it is obvious that various divisions and schools at Duke are moving in new directions. Previously, one professor might travel to another country to teach for a semester or for a sabbatical. But now Duke is exporting entire academic programs -- like Fuqua's intent to operate a new business school for the government of Kazakhstan. The same is true of the Global Health Institute. All this has escaped any vote of approval by the Fuqua faculty, and most important, any Academic Council review because the degrees involved will not be from Duke.

Even so, our imprimatur is on the venture, our reputation at stake. The need for guidelines and oversight is acute.

✔✔ We also asked via e-mail Dr. Merson how much he is willing to bow to foreign governments. For example, the Institute recently awarded "diplomas" in Beijing; while we are unclear if this is the equivalent of a degree, the document bore the Duke name. We wondered if it also bore our seal, the motto "Eruditio and Religio" that is part of our heritage, and the Christian cross as well.

✔✔ We also sought to discuss with Merson his board of advisers. The chair is Thomas Gorrie, also a University Trustee and chair of the board of directors of the Duke Health System. FC has never been able to trace why Gorrie is interested in Duke at all. He's from New Jersey, a former executive at Johnson and Johnson, and a scientist. He is not an alumnus, neither is his wife nor son. He's very well hidden; it took us a long time to find his Princeton NJ office, where there is never any answer.

There Global Health board also includes two University Trustees who were bounced by term limits, and if we are not careful the Institute board will become the last gasp for power by people on their way out.

The two include Alan Schwartz, most famously CEO of the Wall Street giant Bear Stearns that disappeared in the financial meltdown.

And Robert King Steel, who has a long Duke resume. As chair of the Trustee search committee, he discovered Richard Brodhead who was Dean of Yale College. He stood at his side through the lacrosse crisis, abandoning our boys.

Steel came out of Goldman Sachs and was at the top of this Wall Street pig until bounced, and then his rabbi from Goldman made him the #1 federal Treasury official dealing with the domestic economy in the presidency of George W. Bush. Overnight, Steel flipped from regulator to CEO of one of the companies most in need of regulation, Charlotte's Wachovia Bank, which subsequently disappeared too.

Thank you for reading FC and for loving Duke.