Striving To Do Good: Well-Springs, Realities, and Paradoxes of Medical Humanitarian Work

The voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.

All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.

Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly . . . [that] one, tiny being [he] encountered . . . [on ] that hot morning in Sudan," he attests, he "touched Jesus."

Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:

. . . [L]et me summarize my last patient for you: Good luck Dad...