What inspires action in Global Health?

"Why do all of you want to go to the middle of nowhere and take care of the sickest people even though you won't have half the tools necessary to make the slightest difference?" he asks.

I'm sitting in the Intensive Care Unit workroom enjoying one of those rare, calm moments during residency when this question suddenly breaks my peace. A co-resident, my friend from Latin America, makes this inquiry without even looking up, as he clicks nonchalantly through some Internet pages. I look at him and try to understand him within his context; he was born and raised in what is traditionally considered a "resource-poor setting," but through talent, hard work, luck and privilege he was accepted into one of the best residency programs in one of the best U.S. hospitals. Unprepared, I give some anemic responses about social responsibility and global citizenship.

He looks at his screen and clicks on a couple of links. Suddenly, he turns to me and exclaims, "I get it! You guys are going because then you can put your PWAB on your CV!" I give him a blank look.

He stands and goes over to the dry erase board to write: "PWAB—Picture With an African Baby."

I'm amused for a moment, and then suddenly hurt. What does this mean? Is he questioning our intentions, our moral resolve? I look over to his computer and see that he's been flipping through the "Global Health Residency" pages of all the local residency programs, or the Facebook pages of colleagues who have recently returned from work abroad. My hurt morphs into incredulity—all the pages have a picture of a beaming, healthy doctor holding a beautiful, newly happy, previously sick, African baby. And then, the code bell goes off, and the admissions start. Reflection time is over.

Years later, now that I have become a junior faculty member within the same residency program, I divide my year between global health projects in rural Mexico and Guatemala, the classrooms of a U.S. medical school, and the patient rooms of a teaching hospital. The number of undergraduate and medical students who approach me because they want advice about how to work in global health is staggering; their emails fill my inbox and their faces grace my office hours. External observers have even compared the unprecedented rise of this type of interest to "a veritable tsunami," and we often take for granted that this is because the field is "inspiring" (Mallampati & Heintz, 201, p. 22). We still don't know, however, what all this inspiration becomes once it touches down on-site. For many students, the experience with talented mentors on-site opens up for them a life-long career that aims to address the greatest challenges of our day. The PWAB, however, implies that for an important number of other students, global health is becoming a social capital commodity: an edu-vacation, something to make your mother proud, win a mate, maybe even just another mandatory rotation needed to spice up the application for a career in a highly competitive subspecialty.

If students are the future of this field, then the way that global health educators like myself manage this issue may ultimately determine the objectives and scope of countless potential projects hoping to help the billions of people barely surviving abject poverty. I have a career in global health that is more than a hobby because of the clear vision and strong leadership of my mentors and our university (Farmer, 2011). When I was hired as faculty, they worked with me to find the right full-time equivalent (FTE) split so that I could both make a living as an attending, and also still have time to teach, think, research, and manage a project abroad pro bono. But it's from this point that my question begins: once the students are inspired, and the investment made, what inspires good, sustained, pragmatic action in global health?

A big part of the answer to this question will depend on how we define global health. Global health is growing, but...