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113 Advancements in medical technology are truly amazing. Research continues to evolve understanding of the human body, and diagnostic and treatment capacities continue to progress at an amazing rate. Consider that a diagnosis of HIV/ AIDS or some cancers in the 1980s was a death sentence. Today, with access to a proper pharmaceutical regime, HIV positive patients can live a full life and many more cancers can be survived. Our ability to detect and screen various forms of cancer has greatly improved, and late-stage interventions have come a long way. A team of Spanish surgeons successfully completed a face transplant (Siemionow & Gordon, 2010), and robotics have come into the picture. Today, in place of trained health workers, physicians can use robots to diagnose remotely and even operate with the help of a skilled surgeon linked up somewhere else in the world (Mendez, Hill, Clarke, Kolyvas, & Walling, 2005). As these biomedical advancements continue, the ability to prevent suffering from the most basic ailments wanes. Health systems in West Africa, for example, have little capacity to ensure that no child dies of diarrhoea. The medical challenges that most people face in the twenty-first century are a result of dirty water, mosquitoes, and a lack of skilled attendants during childbirth. Over 18.5 million lives are lost each year due to preventable reasons (WHO, 2006). Medical advancements are widely celebrated, but in both academic literature and popular media, inaccessibility to these advancements is rarely discussed . How is it possible to celebrate costly technological advancements while overlooking the structures that prevent access to even the most basic levels of THE BLOSSOM OF COOPERATION: CUBAN MEDICAL INTERNATIONALISM THROUGH ELAM IN ECUADOR CHAPTER 5 WHERE NO DOCTOR HAS GONE BEFORE 114 health care? The answer lies firmly in a normative belief that the production of well-being through health care resources is a costly social burden, and hightechnology innovations, let alone quality care, can come only to the affluent. This belief, however, is a luxury of the financially secure and the adequately insured global minority for whom basic health care is assumed. The problematic assumption with this argument is that advanced and innovative technologies are the only means by which to provide health care. The idea that health care is a costly economic burden that can only be granted to the affluent completely overlooks the importance of low-cost interventions in low-resourced areas. Attempts to improve health-care accessibility in poor areas have been going on since biblical times. Philanthropy and outreach have long been part of medical practice. Rarely, however, has this outreach involved demystifying medical knowledge so that individuals and communities could better take health care into their own hands. In 1973, David Werner published Donde No Hay Doctor (Where There Is No Doctor: A Village Health Care Handbook [1st English edition, 1978]) with the Hesperian Foundation. The book was initially crafted as a basic health-care guide for campesinos (farmers) in Central and South America. Knowing that most peasants do not have regular access to health-care professionals , Werner used basic language and detailed images to guide individuals through various health calamities. The book was meant for community leaders, and many of the treatments called for group-based participation. The guide instructs community health workers on the basics. It explains how to make stretchers and crutches from the materials found in the jungle. It offers lessons on identifying the severity of dehydration in infants, and it shows the basic steps of assisting with childbirth, including dealing with the all-too-common occurrence of counselling a mother when her child dies during delivery. Donde No Hay Doctor makes two major assumptions about the general state of health-care services in the global South. First, as the title implies, it accepts that doctors and health-care professionals will not be there. Second, it assumes that material resources will be absent. These assumptions are based on the lack of health professionals in rural landscapes due to a lack of economic demand (i.e., ability to pay) for their services. Using basic tools, crafting crutches from tree branches, and using basic materials to monitor expecting mothers speaks to the reality of poor communities using whatever resources they have at hand in order to provide some level of care. It assumes that communities will not be able to purchase what they need and that philanthropy will not always get there in time. The poor of this world are forced on a daily basis to make...

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