Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Communication in the Third World: A One-Way Street
(sobrien@denverpost.com). The health sciences literature is not bereft of
such “dicey” examples.
2. The constant new versions and variety of software pushes up the cost and
diminishes the ease of communication. This is especially a problem for
colleagues in developing areas that need to have stability for purposes of
containing cost, of hardware and software. It is interesting that in some
developing countries the cutting edge of software and technical application
is maintained in advance of one’s own pace.
3. The gap of “haves and have-nots” (basically an economic designation) is
expanding faster as the speed of change accelerates. This does not mean
that advances are not occurring in the developing countries, but it does
mean that “catching up”, in a conventional sense, is increasingly impossible.
Catching up is the issue central to this chapter and is discussed
further on.
4. The gap in access to information via the Internet by developing areas is
not so much the issue as is the abject lack of participation by professionals
in developing areas. The research base for conventional health science
endeavors is huge and expanding in economically developed countries. It
is small, as a result of decades of neglect, and shrinking in developing
areas. The information and research in developed countries is so dominant
it excludes and dismisses research generated in developing countries.
The participation of developing countries in the mainstream health sciences
literature is nearly invisible. “Lost Science in the Third World” by
W. Wyatt Gibbs in Scientific American, August 1995, pages 92-99, documents
the severity and rationales of the problem.
Questions and Answers:
1. Does the developing world have anything worth saying?
2. Who speaks for the developing world?
3. What is the content, assuming usefulness in what is submitted?
4. What format is suitable for developing country submissions?
The evolution of information priorities has been slowly changing over the last
15 years. In 1985 there was no question about the need for access to developed
nation’s information in any form from books and paper journals to citation indices.
Over the last 4 years access to the literature in an electronic format via the Internet
has provided cost effective, fast access. What is emerging is a need for realistic reporting
and research by and in developing countries. The need for information
from the West obscured the gross deficiency in reporting by developing countries.
Health care is a global concern and affects all countries regardless of economics of
political boundaries. It is also a reality that most of the world’s population has access
to marginal health care services. This level of health services is going to persist for
several generations and indeed is increasingly catastrophic. HIV in Africa is forcing
reevaluation of how the rich nations are going to relate to the poor nations in matters
of health. This dilemma can be expanded to many other areas of health sciences
like malaria and tuberculosis.
British Medical Journal’s “news extra” (BMJ 2000; 320: 1692 (24 June) reports
from New Delhi a very important insight and perspective that has been too long in
coming. Although the new journal, Austral-Asian Journal of Cancer, is focused on
cancer it “is expected to provide a forum for devising palliative care strategies for
developing countries.” Dr. M Krishanan Nair, director of India’s Regional Cancer
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