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Friday, December 23, 2005 - Page updated at 12:00 AM

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Pacific Northwest Magazine

The Comforter

SO MANY STORIES about Dr. Helene Gayle from all types of people all over the world — and almost all fall into two categories.

In one, the Gates Foundation's glamorous director of AIDS, tuberculosis and reproductive health is on stage, rallying scientists and world leaders. In the other, she huddles with women in a Nigerian brothel, or strolls Calcutta's red-light district, or listens to HIV-infected moms in a New Delhi care home where billionaire Bill Gates is also visiting.

It's 2002, a year after Gayle joined the foundation; a year before Gates would announce an ambitious $200 million plan to prevent AIDS from overwhelming India. The media surround him, of course, but the young moms, all outcast widows, feel more comfortable approaching Gayle. Quietly, they gather around her in a sparse bedroom, everyone sitting on the cement floor. What are your hopes for your children? Gayle asks. Are they discriminated against in school?

During goodbyes, a slender woman in a yellow sari hugs Gayle, sobbing. She says, through an interpreter, that no other doctor has ever treated her like a person. "Here was a doctor interested in their lives," says Ashok Alexander, director of the foundation's AIDS program in India, where physicians often refuse to treat HIV patients. "Helene has a tremendous natural empathy."

She also has a big job.

In February, Gayle will leave Seattle to become president and CEO of CARE USA, an anti-poverty humanitarian organization with an annual budget of $624 million and a staff of 12,000 in 70 countries.

The hardest question . . . how do I leave the Gates Foundation — a place where you give out large sums of money, everyone loves you (or pretends to) and you get to work on important things with wonderful people, Gayle e-mailed foundation colleagues a few weeks ago. My only answer is that I firmly believe that one must be true to knowing and following one's own path and passion. . . . Finally, I hope I have been a good colleague, because I want to be remembered fondly as I move to the "other side of the check."

Foundation President and CEO Patty Stonesifer calls Gayle "an incredible leader, a great scientist, but also a marvelous friend and woman. We are really lucky to have gotten her to help us shape the early years of the Gates Foundation."

At the world's largest philanthropy, Gayle's $1.5 billion portfolio included the quest for an AIDS vaccine; improved tuberculosis treatment and prevention; better access to family planning; the India initiative, called Avahan, designed to be a working model of what it takes to reverse the AIDS pandemic. Other projects touched truck drivers in Botswana, sex workers in China, researchers developing a microbicide gel to protect women from the HIV virus.

Known as a strong advocate for HIV prevention and women's health issues, Gayle has worked on HIV/AIDS for nearly two decades, including six years overseeing the Centers for Disease Control and Prevention's $1 billion prevention program for HIV, TB and sexually transmitted diseases.

Gayle's public-health background dovetails with CARE's top priorities: the AIDS crisis, basic education for girls, better water and sanitation. "But she's not coming on to be CARE's chief doctor," says board member Bowman Cutter, who led the international search team. "She's coming on to be our CEO." Gayle, he said, has a track record leading complicated organizations and partnering with sovereign nations, critical in an era when global health and development overlap with foreign policy.

Gayle's mentor, former Surgeon General David Satcher, says his protégé is ready. In South Africa, when leader Thabo Mbeki said AIDS wasn't caused by a virus, she stepped around the controversy, helping craft a general health program that would also address HIV issues. Gayle "was the one to get you through the impasses," Satcher says. "She'd go have her side meetings with people. . . . I've often said Helene Gayle is the most trusted health worker in the world. People don't necessarily trust the U.S. that much, but somehow, they trust Helene Gayle."

HELENE DORIS Gayle was born in Buffalo, N.Y., in 1955 and grew up during the civil-rights era. Her father owned a beauty- and barber-supply business in the heart of the city's black neighborhood at a time when African-American hair products were not sold in mainstream stores. Jacob Gayle was a pillar; his shop, a magnet. Business leaders and the local Black Panthers came through; James Brown dropped in to buy a comb. "We grew up in that store," says Gayle, who worked there after school. It was "very community-oriented. Customers came in and out discussing politics of the day. My parents taught all of us that contributing back to the community is what we were put on Earth to do."

Though the Gayle family lived in the suburbs, they were tight with a dozen city families, pioneering black professionals whose children played together and were expected to excel. "Helene was very smart, had beautiful human-relations skills, was always helping other people," recalls 85-year-old family friend Thelma Hardiman. "It was the love of the mother. She didn't push, but gave them all the advantages. They were in the library every day after school." (Or at the mall with friends during "library" time, Gayle admits.)

Gayle's late mother, Marietta, was a social worker, intelligent, charismatic, so lovely she was selected queen of her university. She also suffered from severe mental illness, a fact Gayle, until now, has kept private.

"It is only with her death (last year), that I feel it is something I can and should talk about. I hope we can get to a day where a child has no shame talking about a parent with mental illness anymore than (if) their parent has diabetes or hypertension, " Gayle e-mailed after the only conversation in which the ever-articulate doctor was short on words. "Growing up with a parent with mental illness was a source of stigma and shame. The world laughs, mocks and makes fun of 'crazy' people. . . . For all of us, there was a very acute sense of loss because my mother at her best, and particularly in her early days, was articulate, dynamic, brilliant and beautiful. She was a force to be contended with. We (my siblings and I) are all a testament to what an incredible person she was."

Gayle is the middle of five children born within eight years. Her two older sisters, Alana and Karalenne, are lawyers. Her two younger brothers, Jacob Jr. and Geoffrey, have advanced degrees. "We were rambunctious country kids, hollering, playing tag, tousling," Geoff recalls. "Dining times were a rollicking debate — religion, politics, sexuality. We were raised to be free-thinking. Nothing was off-limits."

In seventh grade, Helene was hit by a car while bike riding. She needed traction for six months and was tutored at home. In eighth grade, her parents separated (later divorcing) and her mother moved them to Lancaster, Ithaca, Richmond and Buffalo before undergoing psychiatric hospitalization. The children lived with relatives and friends, attended multiple schools. Helene finally enrolled in an urban public school. "I came in with a suburban middle-class way of doing and talking and dressing," she recalls. "Luckily, I could fight." By the end of eighth grade, she won a citywide award for highest academic achievement.

Where did she find comfort amidst the tumult? "I just got up every morning and kept going," she says. "I enjoyed life, enjoyed school, had good friends and kept moving."

Their mother's illness was "as much adventure as it was difficulty," Geoff recalls. It made the siblings close, gave them a sense of humor and could be why Helene developed deep empathy for stigmatized people.

The gregarious teen created a social-networking empire, everybody's phone number memorized, recalls best friend Leslie Clapp. Both girls completed high school in three years, graduated in the top 10, and became doctors, a surprising turn for Helene since she'd always considered herself primarily a social activist.

"Nixon. Racism. Sexism. Apartheid. Bras. You name it, I protested it," she told graduates during last year's commencement speech at her alma mater, the University of Pennsylvania Medical School. During college, at Barnard, she'd realized health care was a way to address social inequities. Then, in medical school, she heard a speech by D.A. Henderson, a leader in the worldwide campaign to eradicate smallpox.

"BINGO! This is what I want to do," she told herself. "Eradicate a disease off the face of the earth as opposed to treating a disease in individuals."

In 1981, Gayle graduated from medical school, simultaneously completing a master's in public health at Johns Hopkins University. That year, the CDC reported the first five cases of what would later be known as AIDS.

The mysterious disease gained momentum while Gayle trained in pediatrics and public health, then worked for the CDC on child nutrition in West Africa. "Here were these people, incredibly poor in the middle of a drought-stricken area but with the same concerns and aspirations as middle-class suburban Americans in what they wanted for their children. . . . You have this (touching) sense of accident of birth: But for slavery and all that went on, that could have been me."

In 1987, Gayle joined the center's AIDS program and stayed for 14 years, the last six as director with a staff of 1,400. "I often say HIV chose me," Gayle says, because it disproportionately affects people on society's margins, stigmatized. Fighting HIV "means affirming that all life matters and has equal value — whether an injecting drug user in urban America, a young gay man in London or a teenage sex worker in northern Thailand. . . . It is the defining public-health issue of our time."

Not everyone agreed, especially in the beginning.

"Africa, Asia, every country in the world, they were all in denial," says Donna Shalala, who, as secretary of Health and Human Services, worked closely with Gayle. "The health ministers kept assuring us they had everything under control. (Gayle) kept pushing . . . to get programs, strengthen the private sector, the public sector. She just never gave up."

Gayle's clear thinking and willingness to listen make her "a joy to work with . . . even when we didn't see eye-to-eye," says Steve Gloyd, head of the University of Washington's new global health department, who often took the other side in treatment vs. prevention debates. Now, both sides call for treatment and prevention. At stake: 5 million people — nearly 10 times the population of Seattle — who every year become infected with HIV.

Even in the discouraging early days, Gayle was upbeat, pushing for resources and good staff, says mentor William Foege, former CDC director who helped eradicate smallpox, now a Gates Foundation fellow. "All these things add up. In the mid-1990s, things began to look up, but it was only the last three or four years we've seen real hope."

Not enough for Gayle. It's telling that she can't forget the movie "Schindler's List" in which the hero is haunted by lives he didn't save.

"We knew it was going to get worse," Gayle declared during Time magazine's recent global health summit in New York. "For a disease that had such a long incubation period, by the time (the problem surfaces), you're already way behind." In the early 1990s, $2 billion could have halved the number of infections, she says. Global spending was closer to $200 million. Now, UNAIDs calls for $22 billion annually by 2008 to keep pace.

"We waited too long."

URGENCY IS an understatement.

With high spirits and high cheekbones, Gayle almost always looks terrific, so it's difficult to appreciate how grueling her schedule is.

A typical two weeks this fall: Thursday, Paris, world conference on lung health. Gayle delivers a rousing plenary urging listeners to demand better treatment of tuberculosis. Sunday through Tuesday, Washington, D.C., attends annual meeting of prestigious Institute of Medicine; Wednesday, Seattle, meets with grantees; Thursday, hosts discussions on U.S. policy in Africa, including Council on Foreign Relations dinner meeting at exclusive Rainier Club; Friday, chairs staff meeting; Saturday, catches up with countless e-mails, housework, boyfriend; Sunday through Tuesday, London, convenes funders of the Global Vaccine Enterprise to ask for more support; Wednesday and Thursday, New York City for Time Global Health Summit, speaks on panel, interviews on National Public Radio, attends Elton John benefit gala in sparkly green dress; Friday and Saturday, Seattle, chairs International AIDS Society leadership retreat, hosts dinner for 40 in her Mount Baker home.

Of note: No wrinkles (on face or clothing), stylish pointy mules (typical office footwear) and elegant dreadlocks personal pizzazz especially resplendent in a gray-suit landscape. Gayle is a spunky African-American woman in a field still dominated by pale balding heads. She will be the first woman and first person of color to lead CARE in its 60-year history.

"I used to feel pressure to overperform," she says. "There are still times that because of my race and gender people at first glance may perceive me as not being credible or competent. Luckily, that is less the case today than 25 years ago."

If Gayle ever feels lonely or tired at the top, she doesn't complain. "She has no room in her life for self-pity," says boyfriend Gary Thomas, a Garfield High School teacher. "She's about the business of what she's doing. It's a formula that works for her."

Thomas met Gayle through mutual friends and was smitten. Their first date was at Thompson's Point of View in the Central District, dancing to Al Green's "Simply Beautiful" on the jukebox. Though Gayle is gone half the time, he says, "Let's just say, we've been together almost four years and we've had two good years!" The couple is still figuring out how to deal with her upcoming move to Atlanta.

Gayle has never married. She muses, "I guess it wasn't a priority. If it was, I would have done it." She recalls a friend commenting he couldn't imagine her being married and "belonging" to any one person because she belonged "to all of us. Maybe that works for me. But who knows, maybe that changes, too, at different periods in time."

THIS PAST SUMMER, Helene Gayle wore a hot-pink dress to celebrate her 50th birthday aboard a cruise ship on Lake Union, surrounded by the many to whom she belongs: all four siblings; luminaries including Bill Gates Sr.; old friends such as Professor Melvin LaPrade, whose student loans she co-signed when he was a hospital orderly. ("Most doctors do not speak to the orderlies," LaPrade says. "Helene treated everybody the same."); new pals, including Dorothy Bullitt, who doesn't like clothes shopping except with Helene. ("I love seeing someone so alpha," Bullitt says, "who can do the girlie things, too.")

Gayle's siblings taped up posters: Gayle with her hero, Nelson Mandela; in her snappy rear admiral's uniform (as assistant surgeon general); at the Oval Office as President Clinton and Vice President Gore officially apologized to Tuskegee survivors, a ceremony she helped orchestrate. "Finally," she says, "someone admitted this was a real injustice, an experiment that didn't value people's lives."

As for her own life, Gayle says the 50s is a different stage. "You're no longer up-and-coming. You kind of are. Not to sound morbid, but there's a clear, finite sense that I have less time in front of me than I have already lived. It makes you think of how you're going to spend your time. What do you want to say you've accomplished with your life?"

Besides stopping a pandemic, what else is on Gayle's list?

"How about eradicating poverty?" she says.

Knowing Gayle, it's no joke.

Paula Bock is a Pacific Northwest magazine staff writer. Her e-mail address is pbock@seattletimes.com. Betty Udesen is a Seattle Times staff photographer.

Copyright © 2005 The Seattle Times Company

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