Don’t Leave Home Without Them
2007; Project HOPE; Volume: 26; Issue: 4 Linguagem: Inglês
10.1377/hlthaff.26.4.1192
ISSN2694-233X
Autores Tópico(s)Climate Change, Adaptation, Migration
ResumoBook Review Health AffairsVol. 26, No. 4 Don’t Leave Home Without ThemFitzhugh MullanPUBLISHED:July/August 2007Free Accesshttps://doi.org/10.1377/hlthaff.26.4.1192AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InReddit ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth professionalsGlobal healthPhysiciansHealth servicesHIV/AIDSThe urge to perform medical service abroad has always been present at some level among U.S. physicians. In the early years, this often took the form of missionary work. The growth of nongovernmental organizations (NGOs) in the twentieth century provided the vehicle for many others. In recent years, the number of voluntary organizations sponsoring people participating in health in the developing world has proliferated, and the U.S. government itself—through the Centers for Disease Control and Prevention (CDC), U.S. Agency for International Development (USAID)–sponsored programs, and even the military—has provided physicians, nurses, and public health experts for service in the developing world.The magnitude of this “mission” is hard to measure. Johns Hopkins professor Timothy Baker published an estimate in 1987, putting the figure at something less than one-third of 1 percent of U.S. physicians at that time—a victory or an embarrassment, depending on one’s expectations. Today the numbers are surely higher, although quantification remains a challenge, since the length of service, clinical focus, and sponsoring organizations are so numerous and variable.There can be no question, however, that interest in global health among young Americans in the health sciences is on the rise. A recent survey of U.S. medical students concluded that 20 percent had gone abroad (largely to the developed world) during medical school, as compared with only 4 percent in the 1980s. A Pediatric AIDS Corps, sending physicians to Africa, sponsored by the Baylor College of Medicine and the Bristol-Myers-Squibb Foundation, recently tried to recruit fifty physicians. They were overwhelmed by applications from superbly trained young pediatricians and family physicians.But working abroad is not a simple matter. The organizations, countries, clinical needs, obstacles, hazards, and potential for mismatches are many. Once abroad, the U.S. health professional will be working amid a welter of national and international programs, initiatives, and campaigns. A baseline set of questions for anyone considering health work in the developing world should be asked and answered before departure.Edward O’Neil Jr., a U.S.-trained emergency medicine physician, has devoted his young career to exploring and answering many of these questions. He is the founder and president of Omni Med, an organization that tracks medical service opportunities and supports service/teaching programs in four developing countries (Belize, Guyana, Kenya, and Thailand, as of April 2007). O’Neil has published two enormously useful volumes on the subject. The first, Awakening Hippocrates, is a superb introduction to the subject of international medical assistance in the context of global aid and development. Importantly, O’Neil points out that the national instinct to provide foreign aid is not only (not always) a humanitarian matter. Donor-nation economics (who actually gets the money) and national strategic (security) concerns figure prominently in the use of the foreign-aid dollar in general and in health in particular. This is a very important concept for health workers, who often depart with a preeminently humanitarian set of instincts only to find themselves in medical and political settings that are products of forces that go well beyond the humanitarian. In Awakening Hippocrates, O’Neil provides an excellent retrospective view of topics such as bilateral aid (particularly USAID) and multilateral organizations such as the World Bank and International Monetary Fund. He talks at length about NGOs and the nature and role of many of the sponsoring agencies for international health work. He finishes the volume with six profiles of important global health figures, ranging from Albert Schweitzer to Paul Farmer. True to its title, the book is a primer—and a very well-written one—on health and development for physicians and others embarking on work in the field. O’Neil’s perspective throughout is even-handed and nonpartisan. He discusses preeminently political and frequently controversial issues concerning global finance, national development, and donor-country politics in a laudably factual and nonjudgmental fashion. The second volume, A Practical Guide to Global Health Service, is much more of a “how-to” book. It opens with several useful chapters on cultural, health, and travel guidelines for health professionals working in the developing world. These essays are rich in detail and practical advice. The bulk of the book is a detailed and extremely well-organized compendium of information about 300 organizations that recruit health professionals for work in the developing world. Each organization is profiled with key contact information, a brief statement of the organization’s mission, and additional pointers on specific interests or missions of the organization. This database is topped off with a cross-referencing guide that allows the reader to search the organizations by a variety of factors that include items such as “organizations in which training is provided or available” and “organizations seeking couples in which both members are health practitioners.” Taken together, the two volumes form a basic library for anyone contemplating health work in the developing world. O’Neil brings to the field an extraordinary combination of pragmatism and vision. Within the two volumes, the reader will find a call to his or her humanitarian instincts, keen historical analysis, thoughtful political commentary, and the most rudimentary and practical information about how to take care of yourself on the road.As more American health workers go abroad to take on new killers such as HIV/AIDS and old ones such as malaria, O’Neil’s books will provide practical and moral support for them. Fitzhugh Mullan ( [email protected] ) is the Murdock Head Professor of Medicine and Health Policy and a professor of pediatrics at the George Washington University in Washington, D.C. He is also a contributing editor of Health Affairs. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 July 2007 InformationCopyright 2007 by Project HOPE - The People-to-People Health Foundation, Inc.PDF download
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