WHAT CAN I EXPECT?

You and I may be in one of the larger growth industries on earth, and a medical market beyond hyperbole, if you will go where the human needs are greatest. If you have been impressed during your medical education that made you feel redundant and seemed to expose you to an over-cared for, demanding population with sometimes trivial illnesses who expected and received excess layers of high technology care by competing specialty systems that often followed reimbursement patterns rather than health benefits of the best treatment to the neediest patients, you are in for a real role reversal. If you were not present in your tertiary care hospital to look after someone's problem, another provider would be moments later sometimes elbowing you out of the way on the basis of seniority or simply "I saw him first." In the triage through the long queue of patiently waiting people with often desperate advanced disease typical of most third world environments, you are the critical (often, the only) help these poor people will encounter.

You must take care: not only direct clinical care, but you must do more than elevate expectations to be frustrated when you leave. Leave behind a legacy of training others to carry on what you can do. Work hard to work yourself out of the job.

Carry a notepad, a camera (and twice the film you think you will need), a dictaphone, and a very open mind. Make note of what you see that is exotic, but also--quite surprisingly when you come to think of it--what you do NOT see, the majority of the degenerative diseases whose consequences fill most of the hospital beds in your teaching hospital experience here. You may think of reasons for this peculiar absence of some illnesses, and learn what such an environment can teach about health and adaptation. If you leave the USA with the memorized motto "There can only be one correct answer--the way I was taught--to solve paradigm problems, you will quickly learn that these people have subsisted before you or your indispensable method arrived, and will likely have to persisit after you have left, with a negligible percentage of the resources you will waste daily upon your return. Learn how they do it! This is the ultimate in clinical research experiments, long on advanced disease and ingenious adaptations to it and short on high-tech facilities.

Clinical skills are sharpened when the most useful instruments are your eyes, ears, fingers, and the brain that connects them. Much of what is additionally useful is usually the most simple, reusable and practical kind of basic tools--and leave it all behind you when you go home--a flashlight, a book, a stethescope, a few instruments.

And there is one indispensable requirement--an infinitely elevated threshold of frustration. Whatever eloquent excuses are given for why something just cannot be done, nod, smile sweetly, and then set about getting it done--this is the ultimate test of problem-solving skills.

OK, now, where can I go?