Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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430 Surgery and Healing in the Developing World
numbers of patients who will have no access to surgical, medical, or even primary
health care. Moreover, the broad spectrum of urgent patient problems encountered
throughout the world is acutely weighted on the side of surgical care, for which any
expertise is in critically short supply.
With the huge and increasing volume of patients requiring such services, but
never getting them, there is every reason for surgeons to be leaders in the field of
primary and preventive care. The profession of surgery is not limited to the operating
room, since a large proportion of patients would be benefited by not undergoing
marginal operation. Facing an overwhelming queue of patients who might benefit
from surgical services, it is highly unlikely that the surgeon would extend the envelope
of those upon whom operation might be performed, but critical judgement
would exercise careful selection.
I have said to my students and residents that I know a market that may represent
the greatest growth industry in the medical marketplace: If you are operating in the
Third World on patients who are incapable of paying, competition for that kind of
“provider” status seems to melt away at the same rate that the patient volume keeps
increasing.
It was George Bernard Shaw who said, “Do not attempt to save your life; you
will not succeed.” There are only two alternatives—you can spend it (and no rate of
exchange is worth it at any price) or you can give it. The Third World is an appropriate
and ever-expanding beneficiary of this giving for those of us who have enjoyed
more than our share of the First World’s bounties, and paying back some part of the
humanitarian dues that are overdue is rewarding in itself.
Readers of the Bulletin have perhaps noticed a pattern in a series of articles over
the recent past, from historical notes on working in Gabon with Albert Schweitzer; 3
changing surgical practice patterns after retirement and teaching in Tanzania and
Zimbabwe; 4 surgery on the edge of the desert in Galmi, Niger; 5 specialty or short-term
practice under the auspices of missions, humanitarian organizations, or aid agencies;
6 and paired lifetimes of medical adventure. 7
There are many organizations set up to facilitate volunteer short-term opportunities
for American physicians and surgeons, which provide exhilarating and educational
experiences that are often more immediately beneficial to the donors than the
recipients of this aid. For the population served, one of the disservices that might
follow beyond the immediate benefit is the elevation of expectations, which are then
frustrated after the visiting health team leaves—unless the expertise has been left
behind in some indigenized care. To achieve sustainable health care capacity, international
surgical education is a far greater benefit, and the “pairing” or organizations
that may be more partner than patron is a more successful long-range plan. 8
Web Resources
Below are selected websites for agencies and resources for surgeons wishing to
offer their skills to nations in need:
Agency for Health Care Policy Research = http://www.ahcpr.gov/—Home page
for a major government sponsor of research related to clinical practice outcomes and
policy. Though primarily concerned with domestic research, some of AHCPR’s work
is concerned with international research, comparative studies, and cross-national
practice standards. Entering the word “international “ in AHCPR’s search engine
can access studies with international relevance.
American Medical Student Association/Foundation = http://www.amsa.org/
—Home page for AMSA, with links to the AMSA foundation’s International Health