Surgery and Healing in the Developing World - Dartmouth-Hitchcock

“poor, but modern”, as for example, a tar-paper shack with a satellite dish.
In the “Third World” the math is brutally simple: the resources to support
the population cannot keep up with the expanding numbers of people who
must depend on them, so there is a very real and desperate fall in the standard
of living. Classic examples of this stage are found in most of Africa and
some parts of Asia and Oceana. In some instances in the demographic transition,
this assumes the form of a catastrophic collapse, as the burgeoning
population degrades its ecologic support, ruining the environment upon
which it must depend, so that there is an entropic slide as the death rate rises
to match or surpass the birth rate—a very late and tragic, but no less inevitable,
form of population control.
The only way that such a population can be retarded in its decline into
chaotic disorganization is through rescue, relief and rehabilitation from outside
assistance. At present, most such “development agencies” are operating
from the First World through whatever motivations but under donor-imposed
rules and priorities, to try to rescue, or retard, or rarely reverse the
entropic collapse in such populations.
Here is the discouraging fact of the geographic distribution just oversimplified
in naming whole continents as sites of development: First, Second
and Third Worlds can be found within as well as outside political boundaries.
No more than do diseases carry passports, poverty knows no nationality.
There are within a few blocks of the author writing these lines pockets of
poverty comparable in these slums to those of any other Third World nation.
In contrast, the reverse is often true as well, as was once pointed out to
me by Elisa Garrido. She is the economist wife of my friend, Mozambican
chief surgeon Ivo Paulo Garrido, author of one of the chapters in this book.
As we drove through the streets of Maputo just after the Treaty of Rome was
signed bringing to an exhausted end the eleven year civil war that had devastated
the Mozambican nation to achieve the unenviable UN-designated title
of “The World’s Poorest Nation.” Pointing to a Mercedes la Grande passing
us (driven, in this case, by an international aid agency expatriate) Elisa said:
“In the ‘World’s Poorest Nation’ one can still always find the latest model of
the biggest luxury items.”
The frustrations and bitterness that comes from the long and envious
look across this widening gap is apparent in many parts of the world—South
Africa, Eastern Europe, Latin America, the US. The only way that even transient
stability can be erected to barrier off the resentment of conspicuous
greed by abject want is to put armies in between, either as arms of the state,
as employed by some despot indigenous emperors (formerly seen in Romania
or the “Central African Empire”) or private armies financed by industrial
wealth, whether legitimate or otherwise (examples in OPEC states or