June 26, 2005

Freedom from Want: Survival and Hope in a Globalized World

Centerpoint Now Commemorative Issue

It was almost midnight. I lay down and listened to the ruffle of leaves outside, interrupted only by the occasional skirmish of pigs or the snoring of a fellow traveler. Earlier that morning, we had biked our way through winding farm roads to this remote village in the vast mountainous territory of northern Thailand. With solicitous smiles, the young children and teenagers proudly paraded their handiworks in front of my weary, but souvenir-friendly travel mates. Noticeably absent among the greeting party were the men. Presumably, they were too busy to be bothered by a group of foreigners whose idea of entertainment involved expending precious calories on a mountain bike.

“Dis one, very special mista,” shouted a young girl whose worn out t-shirt still loudly displayed the familiar symbols of a famous beverage company. The ubiquitous language of commerce had evidently found its way here, ahead of basic amenities such as water, electricity or medicine.

Later that evening, as the children, wearing their traditional red dresses, danced around a “celebratory” bonfire prepared in honor of our arrival, I couldn’t help but notice a young girl whose left eye was covered by a make-shift bandage. Following the ceremony, I asked if I could examine her. With a cautious smile, she removed her bandage. Her eyelids and orbit were unsightly and inflamed, and, judging from her forceful squinting, she had been in considerable pain for some time. The constellation of findings was consistent with an acute orbital cellulitis, an infectious condition, which if left untreated can lead to blindness and even death. The village had no medical supplies and the closest medical facility was several mule days away. I gave her what remained of my emergency antibiotic supply with hygiene instructions that I doubted were ever going to be followed, given the overall sanitary conditions of the village and its reliance on a single well as a source of drinking water.

That night, as I lay down recovering from the day’s adventures, I wondered what would happen to her when we’re gone. Would she actually take the medicine; or would she discard the pills or perhaps save them for the future? What would’ve happened to her if I had never arrived? Had I caused greater disharmony by giving her a one-time treatment?

Suddenly, among the familiar sounds of the night, I heard a noise that appeared all but surreal. I cupped my ear in an attempt to focus on the sound. To my astonishment, I could make out the familiar patterns of a TV jingle, albeit in Thai. I stood up and awkwardly slinked my way over the sleeping bodies toward the exit. The clear and fresh mountainous sky made the stars seem almost reachable. I followed the sound and minutes later was standing in front of a bamboo hut, a familiar blue fluorescent light flickering through the narrow and uneven slits of its walls. Dozens of villagers were gathered around a tiny battery operated television set, reacting with effervescence to the voice of a presumably famous female pop singer. It was two months before the turn of the millennium, and I knew then that our world had been forever changed.

I have seen this recurring theme numerous times: A Cambodian child beggar proudly blurting out the total population of London in near-perfect English to impress foreigners into rewarding her with dollars, or American evangelical programs preaching righteousness 24 hours a day on Tonga’s only national television channel. More than ever before, the world knows how others live elsewhere, especially in the west. Or more precisely, they think they do, and they want to be part of the action. Some want to resist the force of “the electronic herd,” as Tom Friedman has put it, by retracting into ideology, religion or tradition. Others have embraced it without a script and the necessary knowledge of its accompanying destabilizing side effects. While the overall effect of progress and global economic growth is certainly desirable, there is a darker side to this information swell that requires urgent attention if we are to avert the familiar debacles of the past century.

We now live in a world where close to 3 billion live on less than two dollars a day. Over 2 million die every year of malaria when the treatment costs as little as 13 cents per person. And over 50 million are blind from treatable causes around the world. By all accounts, except for a few exceptional social enclaves, the world is in a state of silent crisis. However, contrary to the past, the average individual is increasingly aware of what he or she does not, or can not, have. I wonder how many of the world’s starving children have seen television images of westerners plagued with the physical burden of caloric overload. Indeed, in most places, a cooking wok and a cheap TV set is all that is needed to join the unilateral stream of the media superhighway.

It is natural to want to jump in and help those we see suffering. Surgeons with international experience often caution against single use medical equipment out of concern that the allure will forever alter local expectations. Unsustainable or disproportionate aid, while satisfying individual egos, may be more harmful in the long run than no aid at all. On a larger scale, many of the world’s so called “hot spots” (trouble spots?) have their roots in withdrawn external support without adequate assurance of long-term stability.

As humans, we share a primal urge for self preservation and self protection. Beyond survival, we all long to better our lives and those of our dependents. Not surprisingly, when people have no hope in the future, no recourse to justice and security, and limited economic potential, social crisis can be anticipated. And those blessed with wealth, opportunity and freedom will invariably become a natural target of envy or resentment.

On a recent medical mission to Cambodia sponsored by the Virtue Foundation, I came across a two-week-old baby girl who had been blinded and disfigured when a female assailant poured car acid on her and her mother as they lay sleeping at night. The life-threatening wounds had left the mother physically and psychologically unable to care for her baby. After several initial surgical interventions, it was becoming clear that without further care the baby’s sight would forever be lost. With the help of dozens of physicians and volunteers, and with the support of the Mount Sinai Medical Center, the mother and daughter were flown to New York and underwent a half dozen restorative surgeries. The question on the minds of all those who cared for this unfortunate family was: “How could anyone do such a thing”?

While it is naive to think evil is ubiquitous to the developing world, it is worthwhile to search for the social root causes of such extreme behavior. Extreme poverty and lack of social justice, limited life expectancy and poor health care in effect cheapens life and makes it dispensable. We are shocked by the images of boy soldiers and child prostitutes. The fact is that in a chronic state of survival, empathy and social customs often lose their hold, with every generation indoctrinating the next into the cruel game of “survival of the fittest.”

If our global tribe is to survive, we need to take drastic and determinate steps to eradicate despair and restore hope. We need to educate ourselves, our peers and governments about the realities of the globe and understand that the world’s plight is not a nicety but a responsibility. We need to understand the consequences of our actions and inactions and come to the realization that much like quintessential butterfly wings, what happens in a remote dusty village in one corner of the globe will affect us in our sleepy suburbs elsewhere on the planet. By individually becoming involved, we indeed take upon ourselves the task of showing the world that we care. In the uplifting words of Jeffrey Sachs “Let the future say of our generation that we sent forth mighty currents of hope, and that we worked together to heal the world.”

Ebby Elahi, MD, FACS, is an Assistant Clinical Professor at the Mount Sinai School of Medicine in New York, specializing in oculofacial and orbital surgery. He also serves as Director of International Affairs at Virtue Foundation.