Surgery and Healing in the Developing World - Dartmouth-Hitchcock

International Surgical Education
Such a surgical milieu can be maintained regardless of government interference.
However, access to the best technology and the highest economic return for individuals
may take a buffeting before the former equilibrium is restored. It is possible
that we will find ourselves on unsettled seas for some time to come, but that should
not deter us from taking responsibility for the transfer of our surgical DNA to the
next generation of surgeons.
Managing Change
Maintaining standards in an era of change requires flexibility, with a primary
commitment to servicing the health care needs of the patient, without compromising
the quality of care now rendered and the progress that might yet be possible in
developing further surgical skills for treating and preventing disease. The developed
world has a lot to learn from the developing nations on how surgical leadership can
adapt and make up in imaginative resourcefulness what it lacks in economic support
or public commitment. People all around the world look to surgeons’ skills for help
when they have a problem, yet do not want to divert a high percentage of resources
to sustaining or advancing the surgical art through public commitment to education
and research.
It was suggested by some in the discussion following each presentation in this
program that the large population demands of Africa represent a call for down-scale
commitment of the resources that cannot be matched in the technology-intensive
tertiary health care centers of the developed world; that, perhaps, primary emphasis
should be on basic health care, with centers of excellence such as those described in
South America serving as role models. Another suggestion was made that Australia
might represent some model of what future American surgeons could expect from
the conflict between rising demand and diminishing resources, with government
interest in controlling public use of surgical services.
Despite widely different educational systems and competitive pressures in the
entry and development of surgical career patterns, the products of these various
systems on several continents have remarkable similarity regarding their stated goals
and objectives: with whatever resources, facilities, technology, and manpower the
system affords, the highest quality of competent and compassionate surgical skill
should be delivered; and surgeons should be taught to address the patient’s problem,
which remains the single focus of surgical attention in a wide variety of geographic,
disease pattern, economic, and educational system settings.
At this juncture in history there is a good deal of enthusiasm for the concept of
“Internationalism in Surgical Education.” This is possible now more than ever before.
The language of modernity, technology, and particularly medicine is English,
so there are fewer barriers to communication of the healing arts. There is a common
literature and even more rapid media to which nearly all professionals make reference.
This universalization of the standards of excellence means that nearly all people
can appeal for the best possible quality where it means the most for them—in matters
of life or death, and in the quality of their daily lives. The healing art is a nearly
ideal transportable skill across artificial barriers among humans. If we recognize the
real problems that isolate people naturally, such as disease, hunger, and want, we
may be able to build bridges around political, economic, and religious systems that
impose artificial barriers on people inhabiting this crowded planet. We have many
neighbors we haven’t yet met; they have heard of us, however, and what they know
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