Charity care may mean crossing U.S. borders

Ethics Forum. Jan. 1/8, 2007.

Is there an ethical imperative for physicians to volunteer overseas?

Medicine can save thousands in developing countries who die daily of malaria, tuberculosis, diarrheal diseases and measles. What role should American physicians play in stemming this tide?

Reply:

My first experience in West Africa was life changing. A series of medical school classes during the prior term had revealed the startling fact that many of the most deadly tropical illnesses had once been prevalent in Europe and the United States -- malaria, tuberculosis, diarrheal disease, measles. Despite being almost eradicated in richer countries, they continued to take their toll on the millions in poorer countries of the world. In addition to being called tropical diseases, they could also have simply been called "diseases of poverty." The medical and cultural experiences that awaited me in Africa were profound.

Living in a village among people in extreme poverty, receiving women who had walked for miles to our half-stocked clinic, watching children die of measles and anemia and malnutrition were at least sobering, and at best motivating, experiences. The inequalities of our world and its consequences on people -- whose names I now knew, whose children played outside our door, with whom I walked to the market in the blazing sun -- became all too real. Any subconscious distinction between "them" and "us" was gone. My moral compass no longer could be distracted by some notion that this was not my problem.