ASIA

Over half the world's population live in Asia, and you will have two million to visit in just two nations alone. The systems of health care are quite different and have a very much higher priority on primary care than specialty practice; much higher emphasis on prevention than on curative medical practice. This can serve as a useful antidote to the skewed sample that US medical students will have been exposed to. But the Eastern World has become a Western "Wannabe" with a big exception according to the wishes of their often draconian, sometimes totalitarian leaders. In the Middle East where I have been a very frequent visitor, this is called "Modernization without Westernization"; this was phrased by the late Zia al Huq of Pakistan, "we want your satellite communication and your transplant immunology, but not if they come along with your values; keep your rock and roll and cocaine."

Equating the latter two as similar American cultural spillover to be avoided may seem a humorous confusion to a westerner, and to some degree may be a partisan Moslem position for internal domestic consumption. There is a very strong yearning on the part of some that would wish to have liberal democracy and human rights as part of the westernization package along with the internal combustion engine (now much closer to a fellow Asian monopoly in much of Asia supplied by Japan). But the autonomy request is they be selective about what comes flooding them from Western sources.

China, Japan, and the Asian Rim Tigers: Language is a problem in much of the Orient for a US student not already acculturated. That does not mean tht there is not much English spoken in medicine (the power of numbers is revealed in the fact that there are more people learning English In the Peoples' Republic of China than there are English speakers in North America!), but this will not help in the communication with most patients. Their systems are already rather well developed in state-sponsored social safety nets, of which health care is just one part.

Unless you have family or friends connecting you inside the PRC or Japan, I would recommend exploring one the "Tigers" such as Malaysia or Taiwan. There are several students with ethnic ties who are going to Korea, or to Hong Kong at this time of transition, but it would be easier for those with no pre-existing connection to look toward the subcontinent.

India, Sri Lanca, Pakistan and the other SAARC countries:

The South Asia Area Regional Cooperative (like counterparts in the better known NATO, The Andean Pact, ASEAN--the Association of Southeast Asian Nations) have interlinked regional ties that might make them a possibility for elective periods in more than one country. I have worked in Pakistan, India and Sri Lanka, with some additional areas in SAARC along the Himalayas and the Maldives, and would have to address specific questions about each, since there is no statement that could blanket cover the billion people of India, for instance. However, there are very long term cooperative agreements with several US institutions and the counterpart organizations in India--from the All India Institute of Research in Delhi to the formerly mission medical schools of Madras and Bangalore, and special relationships with the community of Hyderabad. Sri Lanca is both Tamil (and like much of non-Islamic parts of India, Hindu), but with a majority more like the Buddhist parts of Southeast Asia like Thailand.

Pakistan is a very populous Islamic nation with many institutions with which we have close working relationships, especially with outreach into the poor areas called "kaatchie abadies" for which the Aga Khan University had pioneered student planned health projects under Dr. Jack Bryant who had headed up community medicine there for a decade and now counsels IHMEC (see General Resources for International Health Opportunities.) For special students with ethnic and language capacities, I have arranged experiences in Afghanistan and Nepal and other more remote areas, but with special caution about stability and security of some areas. I would not recommend Afghanistan to someone not familiar with the nation previously, just now, and would recommend that anyone with an interest in Tamil peoples do their planning around Tamil Nadu, India rather than Northern Sri Lanca where there is a very active civil war at present.