On Tending To A Global Village

This is a strange, brave new world indeed. As I surf the Net for updates in post-operative mediastinal infection management, my computer server is being infected by cyber worms and viruses. The Nobel Peace prize is announced as a new "world war" commences. Scholars talk of "Globalization" and "Conflicts of Civilization" in the same breath. Clearly today's world presents great opportunities and dangers. It is up to each of us to make this global village a happy and prosperous place to live, for oneself and future generations. We cardiothoracic surgeons have a unique role to play, as our professional mission is to save lives and improve quality of life for our patients. Thus the call to action by Doctor James L. Cox, past president of The American Association for Thoracic Surgery, in his Presidential Address entitled, "Changing boundaries" is both visionary and timely. Doctors Timothy J. Gardner and Tirone E. David current President and Secretary of the AATS, have followed this up by sending members an International Questionnaire in order to develop a databank in cooperation with the World Heart Foundation. They envision developing an online consultation process around the world, sending cardiac surgical teams to deliver services wherever needed, training colleagues in areas of need in advanced skills necessary to provide care to their patients. These are valuable initiatives deserving of our full support. With the talent in our profession, perhaps there is even more we can contribute. There is a proverb: "Give a man a fish, and you feed him for a day; teach a man to fish, and you feed him for a lifetime."

In April 1995, I was invited to speak in Wuxi, a resort town near Shanghai at a "Conference to Improve Residency Training in China," organized by the Ministry of Health. I was asked to explain the North American Residency Training and Certification process to the delegation, which consisted of two representatives from each of the thirty provinces in China. They invited me since I had residency training and certification in General Surgery and Thoracic Surgery in the US, and later served as Chairman of the Examination Board for Cardiovascular and Thoracic Surgery of the Royal College of Physicians and Surgeons of Canada. But perhaps also because I could describe to them in their own language the Flexner report, the model of Halsted surgical residency, the organizations for Specialty Boards, and so forth. A memorable conversation took place later at lunch, talking to the man next to me who turned out to be a deputy director of health for the host province. I asked what the population of his province was, and he replied it was sixty million. I mused it was about twice the population of Canada. Is it the largest province? He said no, Szechuan province with one hundred million people is. At that point it dawned on me that by speaking to this delegation of 60 people at this one conference, I might be in some way contributing to the post-graduate medical training thus health care of nearly one-fifth of all humanity! The idea was mind-boggling. This experience later motivated me to make time to advise the Medical Accreditation Program as well as the National Health Research Institute (comparable to NIH) in Taiwan and elsewhere.

The superb North American systems of medical education, residency training and specialty certification are the culmination of the dedication and wisdom of our leaders, many of them in our specialty. The importance of such a system and organization in upgrading the quality of professional training and patient care cannot be over-emphasized. One can only operate on so many patients and train so many surgeons individually in a foreign land. Eventually we all shall operate on our own patients and train our own surgeons, wherever we are. By sharing the precious experience one has gained in a country or a continent, we can vastly augment the impact of our local efforts. But there are caveats to such an undertaking.

One can not simply impose a system on foreign soil without knowing the pre-existing conditions. Generosity is appreciated, but ignorance accompanied by arrogance of superiority is not. The successes and idiosyncrasies of the others must be acknowledged, and their wish to have collegial input - and not charity - must be understood. Thus the first order of business is to listen and learn. Exchange of information regarding needs and issues should be a two-way street. This will be facilitated by online exchanges, as foreseen by Drs. Gardner and David, and by panel discussions and symposia during professional gatherings here and elsewhere.

In terms of human resources for such an endeavor, in addition to volunteer active surgeons, we should not forget the many experienced retired senior surgeons. Their wealth of experience in organizational matters, training and health care quality assurance are invaluable. They are no longer preoccupied by busy operative, academic and administrative schedules, but are still physically and mentally too vigorous to golf and fish full-time. Give them the challenge, and they will help their grandchildren by trying to build a better world in this unique way.

Another potential human resource is that of the many surgeons who came to this continent from abroad, as we attract some of the best minds from all over the world. Their knowledge of local issues, people and language make them ideal ambassadors for our profession, enhancing the effectiveness of any voluntary team providing service, teaching or organizational advice.

By extending our collegiality internationally, we gain more than personal gratification or professional kudos. There is but one Global Village in which we live and it is getting smaller!

References

Cox, J.L. Presidential Address: Changing Boundries. J Thorac Cardiovasc Surg. 2001;122;413-418.