I recently was involved in a web discussion on elective choices with a group of medical students. Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy where “want” often exceeds “need. The third world however is completely different. It’s an environment where doctors and nurses are in extremely short supply, disease is rampant, and the health needs are overwhelming. It’s here where we can find the heroes and potential role models of our profession. To date, many are “House”-type professors with teams of subjugate doctors, huge budgets and unlimited technological facilities, or the medical media moguls who dispense advice while they build their own brands, soon to be followed by their own TV programs. Do these doctors deserve to be our heroes? Another popular media figure is the doctor who travels across the world to treat the bizarre cases that other doctors dare not touch. I acknowledge and applaud exceptional surgical skill, but what really does that doctor have to lose? The patient bears the cost of failure, not the doctor. And failures do not make good television programs. Admirable efforts, and I applaud them, but not worthy of hero status in my eyes. I must speak for the benefits of working in the third world. My early medical career has taken me in comfort to places of immense need, and in this, unlike many selfless doctors who work in difficult circumstances, I have been very lucky. Outbreaks of bubonic plague, severe malaria, rampant AIDS at a time the disease was hardly recognized, poisonous snakebites, all seen and treated where facilities were limited, and there was little or no referral base. The challenges were immense, as were the rewards. Could doctors with better skills or specialists have done better? Sure. Did my lack of expertise cost lives? No doubt. But there was no alternative. Overwhelmingly, the gratitude of people who have no medical care for receiving even a little, however insufficient or inadequate, is something that has to be seen to be appreciated. Herein lies the real reward, an experience that has stayed with me as I have moved on in my career, and has been an incentive to do what little I can outside private practice to maintain a service to the indigent and needy. But I am definitely no hero. There are thousands of doctors and nurses all over the world who work in remote, dangerous and uncomfortable places, with scanty resources, and little reward other than making enormous contributions to human lives and comfort. These are the real heroes of medicine, unknown and unrecognized. They deserve our admiration and our praise. If medical students are unaware of these doctors as potential role models, many of the best aspects of medicine may be lost to the new generation of doctors. That will be a sad day indeed. Source
