Danny Thomas's story has a very American ring. Born Amos Jacobs, he was the son of turn-of-the-century immigrants from Bisharri, Lebanon who had settled in Toledo, Ohio. He dreamed of becoming a big-time radio actor, but by the late 1930's, in his mid-twenties, Jacobs was still an aspiring but unsuccessful entertainer, working—sporadically—on the local club and radio circuits. His dream seemed distant. His wife, Rose Marie, was due to give birth to their first child within a week. He was down to his last seven dollars, and didn't know where to turn.
"Help me find my place in life," he recalled praying, "and I will build a shrine dedicated to helping the hopeless, the helpless and the poor."
Days later, an agent recruited Jacobs for a convention skit, and his pay exactly covered his wife's hospital bill. They named the baby Margo, which in time she pronounced "Marlo"—a pronunciation which has stuck ever since. Not long after, Jacobs drove to Chicago to look for work. He landed two radio jobs, and the producers liked him. He was offered an emcee job at a new club, and again he was a hit. Offers came in from the National Broadcasting Company, and in 1940 Amos Jacobs took the first names of his two brothers as the name under which he would make his career: Danny Thomas.
During World War II he entertained at military bases. After the war he moved west to Hollywood, where in the 1950's he produced and starred in the classic television comedy series "Make Room for Daddy." In the 1960's he produced more television classics, including "The Dick Van Dyke Show," "Gomer Pyle" and "The Andy Griffith Show." On stage, he played the big-name, black-tie clubs in New York, Los Angeles, Las Vegas and countless smaller venues. Danny Thomas had found his place in life, and had become a household name all across the United States.
But as his career soared, he never forgot the second part of his prayer on that desperate day. As early as 1945 he began the conversations with Arab-American friends, businessmen and religious leaders that gave direction to his promise. By the mid-1950's, Thomas had decided to found a charitable hospital especially for children, but open to all in need. It would be located in the heartland of the country, in Memphis, Tennessee, where the city made available for sale a 6.5-hectare (16-acre) parcel, slated for urban renewal, next door to an existing hospital.
In 1962, the doors opened at St. Jude Children's Research Hospital, whose mission had been specifically defined as the treatment of, and the search for cures for, "catastrophic diseases" of children—mainly pediatric cancers and sickle-cell disease. It was the first institution in the United States established solely for those purposes.
Now, 37 years later, St. Jude has treated nearly 15,000 children from 60 countries. With some 4,300 children on active treatment, nearly all as outpatients, there are more young cancer patients being treated—and cured—at St. Jude than at any other childhood cancer research center in the United States.
From its opening day until his death in 1991, Thomas stumped tirelessly for St. Jude. So significant were his efforts that in 1981 the US Congress voted him a special Congressional Medal of Honor, one of the few times this award has been granted to recognize outstanding national service by a civilian. Thomas received honorary keys to dozens of US cities and high awards of every variety from around the world. Yet it is more impressive that he remains unforgettable in the halls and treatment rooms at St. Jude. His memory inspires the people who work there, and gives courage to those who seek treatment.
"In a lot of places, as a medical technologist, you're just doing a daily grind," says Margaret Griffith, "You're analyzing samples of this and samples of that from people you never meet." Griffith works in St. Jude's molecular microbiology department. "But here, you follow the child for two, three years, and they aren't just numbers on a sample slip, they're William, or Rebecca, and you can tell how they are doing by what you are doing, and you know that what you do makes a difference in how they do. This was what Danny Thomas created, this way to make everyone feel that they have a part to play."
The most common childhood cancer, acute lymphoblastic leukemia, or ALL, is a variety of the cancer of the blood that strikes an estimated 231,000 children and adults each year the world over. Among them are 2000 children with all in the United States. In the early 1960's, fewer than five percent of children with leukemia survived.
"Leukemia used to be a death sentence," says Dr. Mark Roberts, a childhood leukemia specialist at Houston's M.D. Anderson Cancer Center who worked for nine years at St. Jude. "Back then, even treating children with leukemia was widely viewed as unethical, because you were thought to be merely prolonging their suffering." But Thomas had the courage to build a hospital based on the simple principle that it was not only possible, but actually vital, to fight for the life of every single child, he adds, "and around that idea he attracted a faculty who agreed with him. That idea brought out the best in people."
Medically, St. Jude rapidly became a leading institution in the worldwide fight against cancer. Nine years after the hospital opened, Dr. Donald Pinkel, then its director, revolutionized pediatric oncology by announcing that combinations of chemotherapy, radiation and surgery at St. Jude had achieved a 50-percent survival rate among all patients. Ever since he declared that "leukemia can no longer be considered an incurable disease," the field has grown and diversified explosively worldwide.
Among the 58 institutions that received grants from the National Cancer Institute in 1997, St. Jude's grant was the eighth largest, though St. Jude works only with children. The hospital today carries out extensive tumor treatments, performs some 90 bone-marrow transplants annually, and applies the most diversified gene therapy in the nation. Often working in tandem with their clinical counterparts, researchers at St. Jude expand the frontiers of molecular microbiology, immunology and other fields.
The focus of both research and clinical science at St. Jude, however, remains all and other leukemias. Last year, Deputy Director Dr. William Evans and Dr. Ching-Hon Pui of St. Jude detailed in the New England Journal of Medicine the protocols, or treatment procedures, by which the hospital has achieved the 80-percent all cure rate that—thanks in part to St. Jude's policy of actively publishing its research results—is now the world standard. Similarly, St. Jude's research has helped raise us survival rates for eight other kinds of childhood cancer from their 1962 levels of five to 50 percent to some 60 to 90 percent today.
Yet there has always been one thing missing from St. Jude that is found at most other hospitals in the United States: a cash register. No patient's family is asked to pay for treatment. Those who have medical insurance are not asked to pay for costs beyond what their insurance plans offer. This policy is considered integral to Thomas's vision of service to "the hopeless, the helpless and the poor."
To underwrite this charity, more than half of St. Jude's $150 million annual budget is raised each year by one of the least-known but most active charities in the United States, the American Lebanese Syrian Associated Charities, or ALSAC. Danny Thomas and Indianapolis businessman Michael Tamer, who in the late 1950's was president of the Midwest Federation of Syrian Lebanese American Clubs, formed ALSAC in 1957 specifically to support St. Jude Children's Research Hospital.
Today, ALSAC is most visible in its sponsorship of thousands of "thons": bike-a-thons, dog-walk-a-thons, elementary and middle-school math-a-thons, local and national telethons and, recently, even a dental clean-a-thon. More than 500 country-music stations take part in "Country Cares" radio-thons. With corporate sponsors, ALSAC benefits from sports events, including well-known tennis and golf tournaments and an auto-racing team; Danny Thomas himself once owned a share of the Miami Dolphins football team, earmarking the profits for St. Jude. In living rooms across the nation, there are about 170,000 people who quietly write out a monthly pledge check to ALSAC. Many respond to ALSAC's direct-mail campaign, among the most successful in the nation and the charity's largest fundraiser. In all, St. Jude and its supporters run more than 30,000 events annually that muster the energy of nearly a million volunteers and donors. Thomas is remembered well for his constant reminders to his fellow Arab-Americans that raising funds for St. Jude was a way to honor both their forebears, who brought them to a new country, and their progeny, who were growing up in a nation that was allowed them to succeed to a degree unimaginable a century earlier.
"It was Danny's charisma and Mike's determination," says Richard Shadyac, an early ALSAC volunteer who in 1992 left a thriving legal practice in Washington, D.C. to serve as the charity's national executive director. "It was a two-fold dream, then as now, that on the one hand no child would be refused treatment because of an inability to pay and, on the other, that by building and maintaining this special place we would honor our heritage. For all of us, this is a labor of love."
Today, ALSAC 's board of directors remains predominantly—though not exclusively—Arab-American. "I came [to ALSAC] as a professional fundraiser," says Shadyac's deputy, David McKee, who is not Arab-American. "I've never seen a board as committed to what they are doing as this one. They are not just fighting cancer, they're really giving something to their country."
Compared to many other less specialized hospitals and research centers, St. Jude is of modest size. Some 66 research and clinical physicians and 195 three-year postdoctoral residents see 180 patients each day, only 50 of whom have spent the night in the hospital. Yet among the staff are the winner of the 1996 Nobel Prize for Physiology, Peter C. Doherty, chairman of St. Jude's department of immunology; Dr. Arthur Nienhuis, a member of the National Cancer Advisory Board and director of St. Jude since 1993; National Academy of Sciences members Robert Webster and Charles Sherr; and numerous other people well-recognized in their fields.
"This isn't a city where you'd expect to find a major research center," says Doherty, who despite his prize and his five-continent lecture schedule is a candid, unassuming man. (He describes receiving the Nobel Prize as "quite anomalous, a very strange thing to happen to someone.") Most other cancer research, he explains, is done with the support of research universities, and it is thanks to St. Jude's solid financial position that it can recruit "very good people" who have taken the hospital "from strength to strength" in an atmosphere he describes as "amiable and cooperative, not full of driven personalities."
"We're moving ever closer to the day when acute lymphoblastic leukemia will be known as a serious, but curable disease," says Nienhuis. He explains that, as researchers better understand the myriad genetic abnormalities that can give rise to leukemic cells, they are developing correspondingly customized treatment plans, using multi-drug regimens that are more effective because tracking methods are also becoming increasingly sensitive. These tracking strategies have also led to techniques to reduce the severity of the side effects of treatment.
But all is less than half the job at St. Jude. In 1997, St. Jude researchers demonstrated that bone-marrow transplants, long proven effective against leukemia, could be just as safe and effective using genetically matched, unrelated donors as between carefully matched siblings. This expansion of the donor pool has given new hope to the more than two-thirds of patients who are eligible for a bone marrow transplant but lack a sibling donor.
Other research has focused on combining gene therapy with molecular microbiology, a rapidly expanding field in which selected genes are introduced into the cells of a tumor to make the tumor more vulnerable to chemotherapy or other treatments. Success in this technique is prompting development of a vaccine to genetically modify a sample of the patient's own cells in order to provoke an anti-tumor response in the body, reducing dependence on chemotherapy with its side effects. This approach was used in 1995 when St. Jude was the first in the world to use gene therapy on brain tumors that had proved unresponsive to chemotherapy.
In the 1980's, with the public support of Danny Thomas, St. Jude was also among the first institutions to seek out and enroll pediatric aids patients. Today, St. Jude researchers Karen Slobod and Julia Hurwitz believe that, among the more than 300 aids vaccines currently in development, theirs is unusually promising. Based on the principle of the smallpox vaccine, which uses the harmless envelope of the disease agent to trick the body into an immune response, their vaccine uses not one but 23 envelopes, each a variant of the highly mutable human immunodeficiency virus (HIV). No previous attempt to make an AIDS vaccine has used more than two envelopes. Safety trials of Slobod and Hurwitz's vaccine began in August, and will be followed by a series of progressively more detailed tests that could take as long as a decade.
"When you put aggressive science right next to the clinical work of the hospital, then you get a remarkable combination," says Slobod. "We believe that our advantage over pharmaceutical developers is that, when we have questions, we can get them answered in the clinic right away. I've never worked in a place quite like this, where research and clinical work so closely together."
Despite the advances, the global view of childhood cancer is grim, for more than 70 percent of children with cancer worldwide do not have access to medical services comparable to those in North America and Europe. In response to this situation, St. Jude in 1991 established the International Outreach Program, and its strongest effects today are in the Arab world and Latin America. The program has supported the development of pediatric hematology-oncology (blood-cancer) clinics at hospitals in Beirut, Lebanon and Amman, Jordan. Through the program, St. Jude has hosted doctors and patients from these and eight other Arab countries.
In 1997 the King Faisal Specialist Hospital in Riyadh opened its Children's Cancer Center. The son of Dr. Nasser Al-Rashid, its founder, was successfully treated at St. Jude in the 1980's. The Riyadh center now has three doctors on staff who have worked at St. Jude, and another, Dr. Abdullah Baothman, arrived in February for a month's cross-training.
In the western hemisphere, one of the most successful affiliate programs is Ayudame a Vivir ("Help Me to Live"), founded in 1993 in El Salvador by Ana Lina Bonilla, whose son was stricken with all and was treated at St. Jude, but did not survive. Ayudame a Vivir supports a hematology-oncology clinic in San Salvador, and—thanks in large part to that clinic—the survival rate for all has risen from nearly zero in the years of the country's civil war to 61 percent today. In Chile, members of that country's extensive Palestinian community have initiated a capital campaign modeled on ALSAC, and they hope to break ground for a bone-marrow transplant clinic in the next few years.
Despite the reach of St. Jude's reputation, its Arab roots are not always well known—even among its Arab staff and patients.
"I kept seeing 'SJCRH' on important pediatric hematology-oncology research papers, and I knew the facility had an excellent reputation," says Dr. Najat Daw, who received both a bachelor's and a medical degree from the American University of Beirut. She joined St. Jude in 1996 as a postdoctoral fellow, and she is now a staff physician. "I had no idea the hospital was founded by another Lebanese-American. It made me very proud."
Dr. Basil Abushullaih, a pediatric hematology specialist for the Saudi Arabian Oil Company (Saudi Aramco), also came to St. Jude for the postdoctoral program following two years at the company's Dhahran Health Center. At St. Jude, he worked in both patient care and research, and he teamed up with Daw to publish a paper on a new medicine that stimulates blood-platelet production to enhance a child's recovery from chemotherapy.
"In Saudi Arabia, there are an estimated 1000 new cases of childhood cancer each year," said Abushullaih shortly before his return last year. "Now, if I need a consultation or I have a technical question, the researchers and medical staff I worked with [at St. Jude] are only a phone call away."
While St. Jude's researchers, physicians and fund-raisers are justifiably proud of their work, it is the young people there—the patients—whose work each day is truly the hardest. Cancer robs children of security, and it forcibly alters their sense of identity. Treatment takes them far from home, out of the routines of friends and school, and as promising as the treatments may be, they are frequently grueling and painful. All this also forces unexpected hardships on parents, siblings and extended family. At St. Jude, families facing these hardhips meet and, with faith, humility and the support of staff, struggle to find the grace to endure.
Most find it. Some even find unexpected perks: Logan Luck, an eight-year-old all patient from Halls, Tennessee, got to speak on a Memphis radiothon the day before he was to receive his weekly chemotherapy. He was feeling good that day—often, he doesn't—and his white blood cell count was high enough so that he didn't have to wear a filter mask to protect his immune system. Logan was diagnosed last October, and he has begun to give his own encouragement to new patients, who are frequently frightened and confused.
Logan and his parents had come to St. Jude the previous day, leaving his younger brother with grandparents, traveling an hour by car, and staying in a Memphis motel—where St. Jude paid the bill, as it presently does for all out-of-town patients. "I was just saying the other day that we're real lucky to live so close," he says. "The people from other countries have it hard."
Khalid Mustafa has had it hard. He was diagnosed with a neuroblastoma—a malignant tumor—in Baghdad in 1995, but specialists there had no treatment to offer. As his condition became desperate, an oncologist who had studied in the United States secured Khalid, then seven years old, a referral to St. Jude. His father, Raaid, was a former Iraqi Oil Company worker who spoke English and was familiar with international travel. He traveled with Khalid to Amman by bus, and the two spent three weeks in a hotel, waiting for visas and trying to find an airline that would take them without exorbitant "stretcher-space" charges. Finally, the US embassy intervened and they received their passage, but Khalid was by then so weak and wracked with pain he had to be carried in a bassinet, and he weighed "only about 10 kilos" (22 lb), says Raaid.
"I heard doctors say that he would not live for two hours," Raaid recalls of his arrival at St. Jude.
Khalid was assigned to Dr. Najat Daw, who had only arrived recently herself, and could speak Arabic with the family. "He was my first patient," says Daw, and over the 14 months of intensive treatment, "he became like a son to me. He is a remarkable boy."
These days, although not free from cancer, 10-year-old Khalid has good days as well as bad ones. On the good days he has an easy smile, and he plays with his new baby brother, Muhammad, born last August in Memphis, where the family lives while Khalid is being treated. On the bad days, his family takes comfort in all that their son has surmounted to date. "We can only continue to hope," says Raaid.
As new patients come from around the country and the globe, some 500 each year, the St. Jude staff and its global community of supporters find that their common purpose bridges many differences of culture and religion. Danny Thomas himself once remarked that it is well-known that the Arab world, and Arab-Americans, thrive on hearty arguments, but "this is one organization we can all agree on."
"When Danny died," says David McKee of ALSAC, "we looked around for another spokesman. We were worried: Who would carry it? But then we realized that it ought to be the kids. So now they are our spokespeople. They travel, they ride on the Rose Bowl float, the appear with the race team and so on. They love it. And that's great, because they are the real heroes around here."
Indeed, the children of St. Jude, thousands of whom are now "alumni" living around the world, are the bearers of a hope that did not exist four decades ago, a fiercely courageous hope that inspires, unifies and endures to bring out the best in whomever it touches. It is the hope kindled by a promise made one day by a struggling Arab-American entertainer from Toledo.
Barbara Faber is creative director of Third Coast, an advertising and video-production firm in Houston.
Dick Doughty is assistant editor of Aramco World.