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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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CHAPTER 4<br />

International Surgical Education:<br />

The Perspective from Several Cont<strong>in</strong>ents<br />

Glenn W. Geelhoed<br />

In <strong>the</strong> “global village,” societies on each cont<strong>in</strong>ent are almost <strong>in</strong>stantly aware of<br />

advances <strong>in</strong> medical science <strong>and</strong> technology, <strong>and</strong> <strong>the</strong> dem<strong>and</strong> for surgical health<br />

services <strong>in</strong>creases with this awareness. As communication fans <strong>the</strong>se health service<br />

expectations, <strong>the</strong>re is additional awareness that health expertise <strong>and</strong> resources are<br />

not accessible to all <strong>the</strong> globe’s populations, though each shares much of <strong>the</strong> susceptibility<br />

to disease <strong>in</strong> common with persons on ei<strong>the</strong>r side of any borders—political,<br />

cultural, economic, racial, <strong>and</strong> l<strong>in</strong>guistic. To ease <strong>the</strong> pressures brought about by this<br />

disequilibrium <strong>in</strong> supply <strong>and</strong> dem<strong>and</strong> for specialized health services, <strong>the</strong> educational<br />

systems <strong>in</strong> several areas of <strong>the</strong> world have adapted to <strong>in</strong>creas<strong>in</strong>g dem<strong>and</strong>s for both<br />

quantity <strong>and</strong> quality of surgical services.<br />

The globe is far too small for people, particularly health care professionals, to be<br />

prov<strong>in</strong>cial. Diseases do not carry visas, <strong>and</strong> poverty, want, <strong>and</strong> despair look very<br />

much alike on ei<strong>the</strong>r side of any border. Our responsibility is to educate health care<br />

manpower for global health needs, particularly <strong>in</strong> <strong>the</strong> medical centers of <strong>the</strong> developed<br />

nations. Many of <strong>the</strong> students <strong>in</strong> various health care systems are pattern<strong>in</strong>g<br />

<strong>the</strong>ir careers after <strong>the</strong> role models <strong>the</strong>y see <strong>in</strong> <strong>the</strong>ir own, perhaps atypical environments.<br />

Later <strong>the</strong>y will experience environments that are quite different—geographically,<br />

socioeconomically, politically, <strong>and</strong> medically “exotic”—<strong>and</strong> <strong>the</strong>ir medical<br />

education should be relevant. This is true not only for <strong>the</strong> traveler, <strong>the</strong> Peace Corp<br />

volunteer, medical missionaries, <strong>and</strong> <strong>in</strong>ternational bus<strong>in</strong>ess people, but also for <strong>the</strong><br />

physician <strong>in</strong> community practice, to whom exotic problems may be brought on an<br />

<strong>in</strong>creas<strong>in</strong>gly regular basis because of <strong>the</strong> fluid nature of <strong>the</strong> world’s transportation<br />

<strong>and</strong> communication. A broader vision is needed with a global perspective on health,<br />

health care, <strong>and</strong> medical <strong>and</strong> human problems across <strong>the</strong> globe without <strong>the</strong> conf<strong>in</strong>es<br />

of geographic, economic, or political boundaries. Although many of <strong>the</strong> advances <strong>in</strong><br />

<strong>the</strong> developed world are quickly published through <strong>the</strong> develop<strong>in</strong>g nations, often<br />

<strong>the</strong> problems faced with<strong>in</strong> <strong>the</strong>se develop<strong>in</strong>g nations are unknown with<strong>in</strong> <strong>the</strong> devel-<br />

Editor’s notes: This article is based on presentation at a panel discussion on International<br />

Surgical Education, which was held at a recent Cl<strong>in</strong>ical Congress. Dr. Geelhoed<br />

served as chairman of <strong>the</strong> proceed<strong>in</strong>gs, which were sponsored by <strong>the</strong> Committee on<br />

Surgical Education <strong>in</strong> Medical Schools. Contributors to <strong>the</strong> article <strong>in</strong>clude: Samuel Adetola<br />

Adebonojo, MD, FACS, Professor of Cardiothoracic <strong>Surgery</strong>, University of Lagos, Nigeria;<br />

Jose Felix Pat<strong>in</strong>o, MD, FACS (Hon), Chairman, Departments of <strong>Surgery</strong>, Cetro Medico<br />

de los Andes, <strong>and</strong> former Health M<strong>in</strong>ister of Colombia, Bogota; <strong>and</strong> Thomas S. Reeve,<br />

MB, BS, FRACS, FACS, Professor <strong>and</strong> Chairman, Department of <strong>Surgery</strong>, University of<br />

Sydney, Royal North Shore Hospital, Sydney, Australia.<br />

<strong>Surgery</strong> <strong>and</strong> <strong>Heal<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> Develop<strong>in</strong>g <strong>World</strong>, edited by Glenn Geelhoed.

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