Rites of Passage: Docs and Nurses in the Developing World


A new rite of passage is taking hold among ambitious young doctors entering modern practice in a new century. It can take a year or two after medical school: working far corners of the poor world, and sometimes later years split back and forth between a community clinic in rural Malawi and a neurology fellowship at Mass General in Boston. The trend is striking: of the new medical doctors coming out of US medical schools in the mid-80s, one in twenty had spent some real time abroad in healthcare.  Ten years ago it was one in 5. Last year it was one in 3.  So more and more doctors, yours and mine, acting locally, will be thinking globally, with many implications.

Our radio conversation is about the lessons that flow both ways.  Some have to do with technology and drugs, but many more with building ground support in community clinics; also with the training of nurses, even with refining the bedside manner and hands-on, make-do skills of American doctors who arrive, as they say, with “sandals on the ground.”  They come back “thinking different” about who needs what kind of doctoring in the States. Consider this, for example: Bill Gates’s foundation report this winter predicts there will be no more poor countries by 2035, that’s two decades out; we’ll just have an awful lot of poor people in middle-income countries.   We know that problem in the US, and we haven’t turned it around.  But there are clues out there in the developing world and lessons coming home with the young doctors: lessons in community care outside the big hospital ERs; lessons in “accompanying” care, lessons in prevention, in doing more with less and getting sharply better outcomes, also in putting moral urgency behind more effective care for everybody.


  • Ophelia Dahl is the executive director and a co-founder (with Paul Farmer, Jim Kim, the late Tom White, and others) of Partners in Health, the Boston-based non-profit that has taken as its mission to bring great health care to the world’s poorest people and “to serve as an antidote to despair”.
  • Dr. Daniel Palazuelos is PIH’s chief strategist at its site in Chiapas, Mexico, and directs their efforts to ensure the success of their community-health workers, who are charged with the “accompaniment” of patients.
  • Pat Daoust is the chief nursing officer at SEED Global Health, an organization dedicated to training a new generation of health professionals for work in the developing world. Daoust has served as one of the leading figures in HIV/AIDS nursing for decades, first with the AIDS Action Committee, then with the Harvard AIDS Initiative in Botswana and Ethiopia.

Reading List

  • In “Partners in Help,” Paul Farmer gives an ethos of “accompaniment” to those working with the poor and the ill — work tirelessly, with an open mind, and until you’re no longer needed:

There’s an element of mystery, of openness, of trust, in accompaniment. The companion, the accompagnateur, says: “I’ll go with you and support you on your journey wherever it leads; I’ll share your fate for a while. And by ‘a while,’ I don’t mean a little while.” Accompaniment is about sticking with a task until it’s deemed completed, not by the accompagnateur but by the person being accompanied.

  • Slow Ideas,” Atul Gawande’s latest essay in The New Yorker, tells us that the important changes in medicine will depend not on easy technological fixes, but on big and sometimes grueling social change.
  • In “From Haiti to Harvard,” on WBUR’s own Commonhealth blog, Rachel Zimmerman tells of the difficulties that community health workers in Boston face every day — and of the promise they represent for the American medical establishment.
  • Our guest, Dr. Daniel Palazuelos, wrote a short piece about the myths and realities surrounding community health workers abroad.
  • And the 2014 annual letter of the Bill and Melinda Gates Foundation looks forward to the hoped-for end of global poverty as we know it.

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