Anyone who has travelled to another country knows that language holds great insight into how a culture views the world. The words we choose provide understanding into how we view the complexities of our society.
There are many words we use to categorize countries. Ways that we make clear that not all countries have the same privilege or infrastructure, and to make clear that our country is not one of those countries. These labels are so ubiquitous, that I find myself using these terms to describe geographical regions without even considering what name I am calling them, or what truths or lies I may be declaring over them. Let’s consider a few of these terms:
“Third World Country”. This is a name I often hear to describe countries where most of the population does not have access to surgery. But what does that mean? This term came about during the cold war. It was first used by a French anthropologist, Alfred Sauvy, in an article published in 1952. Countries that aligned with the capitalist NATO allies were termed “First World”, those that aligned with the communist Soviet bloc were termed “Second World”, and those countries without a dog in the fight were labelled “Third World”. Somehow, over the years our culture has come to associate this term “Third World” to mean a country where too many people live in poverty.
“Developing Country”. How do we decide which countries are “developing”? My first job after surgical training was in a region of the United States with a great physician shortage. I worked at a free-standing children’s hospital, but that hospital did not have a pediatric neurosurgeon, urologist, cardiac surgeon, geneticist or child abuse consult team, among other things. There were no vascular surgeons in a region of over 2 million people, with one of the highest incidences of diabetes nationally. Many of my patients lived in the “colonias”, which are shanty houses with no plumbing or electricity. Basically sheds that you would tear down if they were in your backyard. In our “developed country”, I fear that many of us only think these types of conditions exist in the “s*#t-hole countries”.
“Underserved Country”. When I think about all of the funds raised, grants that have been given, non-profits that have been formed, in-country champions who have worked, healthcare professionals who have volunteered, hospitals that have been built and advocacy efforts that have been carried out, I find it hard to say that certain countries have not been “served”.
“Low-Resource Country”. As inhabitants of high-income countries, we consistently tell low-income countries that they have no resources. Is this really true? Most of the world’s coffee and tea production come from the countries with the lowest incomes. Botswana and Democratic Republic of Congo are among the top 5 diamond producing countries of the world. The list of resources available in low-income countries is quite remarkable and will not be elaborated upon further here. However, as we tell these countries that they have no resources, I fear that they start believing what we are saying. This further encourages the misallocation of great resources.
When we classify countries with these names, it unintentionally reflects a certain way of thinking. This way of thinking believes “These countries are poor and unorganized. That is just the way things are, and the way things always will be. These countries will always be poor and unorganized. The best we can do for them is a few missions trips every so often, and perhaps we can make a drop in the bucket.”
Let’s step back and think (and speak) differently. The percentage of people living in absolute poverty in our world is dramatically dropping. Access to clean water is continually rising. Most of the world now has access to the internet and mobile phones. Infant and maternal mortality is plummeting worldwide. The numbers of individuals dying from AIDS has dramatically declined. In 1980, less than 20% of the world had been vaccinated against tetanus-diphtheria-pertussis; In 2011, over 80% of the world had been vaccinated. Our world is dramatically changing and much of it for the better! Access to surgical care is a problem for which a solution can be found. It is within our reach.
We do face many challenges in global surgery, and there is much work to be done. Let’s stop isolating ourselves and instead engage in the work. Not every surgeon is meant to travel thousands of miles to work with trainees in low-income countries or obtain grant funding for global health projects. Every surgeon can change the words we are using and the way we view those countries with limited access to surgical care. If we change what we see, we will change the words that we use. We will come to realize that the notion that there is a 1st, 2nd and 3rd world is nothing more than a fallacy and in fact there is just one interconnected world. We will come to realize that the surgeons working in other countries are our colleagues and we will work together to find answers to the toughest problems that plague us all.