Earthquake lends metaphor for medical rehabilitation

Gerben DeJong ’68


Fall 2013

Gerben DeJong ’68 was a visiting fellow with the University of Otago in New Zealand after the devastating earthquakes that rocked the Christchurch area in 2011. As he and his wife, Janice De Haan’69, toured the ruined buildings of Christchurch, a powerful metaphor for rehabilitation emerged for him.

“There has been a rousing debate in New Zealand about reconstruction,” he said. “The preservationists wanted things to be rebuilt pretty much the way it was before the quake—a huge cost—while others wanted to reimagine and reinvent the city with an eye to the future.

“It occurred to me that a person who sustains a catastrophic physical injury or disabling event often faces a similar choice about his or her future and rehabilitation: Do I want to reconstruct myself just as I was before—usually the first choice, which may or may not be possible—or do I reimagine who I am and who I might become given what has happened? I found this to be a useful metaphor in thinking about the rehabilitation process and rehabilitation research priorities.”

Now a senior research fellow at the MedStar National Rehabilitation Hospital and a professor at Georgetown University’s School of Medicine in Washington, D.C., DeJong never considered the health sciences and rehabilitation. He was an economics major at Calvin because he thought that economics would keep the most doors open after graduation.

After Calvin, DeJong was drawn to public policy and earned two related master’s degrees at the University of Michigan and later a PhD in the field from Brandeis University.

“I was particularly intrigued by how public policy and tax policy, in particular, shape human behavior—and then found doors opening in areas related to health care and disability. I simply chose to walk through those doors,” he said, and “found ways to integrate clinical research with health outcomes and health policy.”

DeJong sees an “unbelievable” array of opportunities in the new health care law for health providers in both acute and post-acute rehabilitation care.

Although the Affordable Care Act has been a source of political wrangling and contention, DeJong thinks that many “overlook the upsides” of the law, and that the law “offers an incredible tool box for those who want to innovate.”

For example, he notes that many practitioners do not look much beyond their own silo of care mainly because our current payment system encourages siloed thinking and management.  Under the law’s bundled payment initiative, for example, providers along the entire continuum will have to work together in managing an entire episode of care; they will be held accountable for both outcomes and costs. Bundled payment will link acute hospital, rehabilitation center and home health care providers together at the start of care; it creates incentives for providers to partner with one another.

“Some have anxieties about our national health care future; I choose to see opportunities,” he said.

At times, advances in medical rehabilitation happen slowly, but DeJong asserts that when one takes the long view, one can see “tremendous progress,” especially in how we manage and deliver care.

“When you stand back and look at how far we’ve come, it is striking,” he said. “The disability rights movement began in the 1970s when I entered the field. The Americans with Disabilities Act, the ADA of 1990, is already more than 20 years in our past. We are now in a very different place than we were. People with disabilities have many more choices today, but we still have a long way to go.”

These days, De Jong is regularly asked to lecture internationally and in recent years has spent considerable time in New Zealand and China.

He notes that China has a “huge gap in both post-acute care and long-term care capacity.” And with the nation’s “one-child policy,” there is an unsustainable recipe for a legion of aging adults without enough family members to assist in their care—as is the Chinese custom.  

“My commitment to rehabilitation research is global,” De Jong wrote in response to a question about what inspires him in his field. “I believe deeply that what we attempt to do generalizes to the aspirations of all humankind, in all parts of the world—the young man in Afghanistan who steps on a land mine and needs a prostheses, the young woman in Ethiopia who suffers isolation and inactivity because of a fistula and needs physical therapy, and the child in Tanzania who has a developmental disability and needs speech therapy. We owe it to them to be, and do, everything we can to make this a better world.”