“We are all here on earth to help others; what on earth the others are here for I don't know.” H. Auden
With the start of the new semester come many questions from our “Public Health & Surgery” students. One of the most common is why we have been working in global surgery for so many years. There are, of course, many statistics regarding the tragic situation of surgery and anesthesia in low and middle income countries (LMICs):
These are certainly emotive numbers, and I am sure they have motivated many practitioners to devote careers to help improve the conditions for patients in the under-resourced world. For me, however, appreciation of these numbers came after my commitment to ‘the cause.’
My indoctrination to global health started as many do, with a service-provision trip to West Africa. My colleague and I had been invited to accompany a surgical team to provide anesthesia for children having ophthalmic surgery. Once on-site we met the physician anesthesiologist who was single-handedly running one of the two nurse anesthesia schools in the country. This gentleman was working 80 hour weeks providing anesthesia care, supervising qualified nurse anesthetists, and teaching classes of 40 student nurse anesthetists. The institution in which he was based tried to support his endeavor, but was limited by its inadequate and desperately oversubscribed budget. 6 Still, our friend persisted – for over 20 years slowly nurturing the practice of anesthesia in his little corner of the low resource world. Now, thanks to his efforts, the institution in question has many physician anesthesiologists, an anesthesiology residency, and a robust nurse anesthetist program that trains providers for their own, and adjacent under-staffed countries.
When I first met our friend, I felt a moral and professional obligation to help. Not by intermittently providing service on surgical missions, but by assisting in his work. He was the one who knew the needs, cultural and practical hurdles and mechanisms for improvement. 7 We had educational resources and expertise – he knew how to apply them.
Since those early days this has been my abiding belief; we are here to help, not to do. The fellow professionals we assist are often choosing to stay in a poorly-paid, over-worked and perhaps dangerous 89 position, rather than emigrate to a better situation. 10 They do this with an optimistic vision, and a sense of loyalty and commitment to their fellow citizens and homeland. Not infrequently this necessitates long-term separation from their families.
Collaborating with (rather than directing) these dedicated providers serves as our resignation from the ‘white savior industrial complex’. This abnegation alone is worthwhile, but in addition it places us in the enviable position of helping real heroes.
References