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Generating ideas

Year: 1995
Setting: Ialibu Hospital, Papua New Guinea
Position: Chief medical officer for Chevron, Papua New Guinea
Mission: Delivering a check to the manager of the Ialibu Hospital to buy a new generator

The helicopter is hovering over a kind of wasteland at the bottom of Mount Ialibu, a massive volcano in the Southern Highlands province of Papua New Guinea, waiting for farmers to clear the area so it can land. Right after we softly hit the ground and alight, my wife and I find ourselves amidst a crowd of dozens of Guineans dressed in full ceremonial attire with grass skirts, bows, arrows, shields, painted faces, bird feathers in their hair, pig teeth necklaces and other cosmetic distinctions. They form a double hedge, in between which we walk. They hop up and down, sing and yell in a very impressive way.

After 20 to 30 minutes, we arrive at a soccer stadium where a podium has been erected and I make a speech before hundreds of people gathered for the occasion. All goes well and next we go to the hospital, surrounded by a crowd that has swollen to thousands. There, I am directed toward the emergency room and asked to wait. As I wonder why, the entrance room doors flap open. A man on a gurney is wheeled in and then placed on the operating table. His clothes are covered with red merbromin, a topical antiseptic that stains the skin. Pseudo-surgeons lean over him and pretend to start an operation. Abruptly, the power goes off, and the hospital manager turns to me and says, “It is too bad that the patient has to die.”

I can see in his eyes that he expects me to show a compassionate reaction to the situation. His anticipation rapidly becomes amazement when I dive into an angry diatribe and utter: “How can you let this happen? Can’t you think of anything to do to get some light in this room?” I run outside to the parking lot and ask nurses to place their cars in front of the ER windows with their high beams on, as I had seen done in the Congo in power-failure situations.

I go back inside the building and am greeted by sullen faces. The theatrical staging has fallen flat, and some are worried that the hospital might not receive the money it had been expecting. We then go to lunch, exchange presents and speeches and morals of our stories, laugh about them and I happily hand over the check. The money will be used to buy a generator that will guarantee a power supply not only to the ER but also to the refrigerators where vaccines are stored.

Lesson for the doctor: Working in a developing country is often rewarding professionally and personally, but beware that chronic aid can create dependency and intellectual complacency.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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