It's A Mad, Mad World

by John Loofbourow, MD

Remember the film by that name, and the typically British humor of the lyrics in the title song? To paraphrase, ours is the third planet out from a star called Sun, in an outer spiral arm of a galaxy called the Milky Way. Was that milk spilled across the night sky by a mythic maddened English cow? This earth supports many different human worlds, separated by time and space: Sumerian, Aztec, Greco-European, Sino- East Indian, African, Semitic, Aboriginal, and New World (American), to name a few. Temporally co-existing worlds may collide in war; and through commerce, exploration, or the recondite research of scholars. In any case such collisions lead to change, sometimes difficult, but in the long run usually called progress. Physicians, like others must deal with such change. We, like others of the last five generations of have had to adapt to a geometrically accelerating technology of communication, automobiles to internet. Both physically and intellectually, we must cope with a tremendous burden of new raw material daily. Not all incoming data is accurate or benign, and the ideas to which we are exposed are more powerful than mere facts. In terms of philosophy and military or economic power, historian Will Durant observed that whenever "Western" civilization encounters the "Orient", the former is seduced and changed, and becomes hesitant or weakened; he cites Greece of Alexander and Rome of Caesar, and I would cite Viet Nam and the Great Society of Johnson.

Loss of our own innocence about patriotism, religious faith, family, and sexual or marital certainty, has had a disturbing societal effect. (Or is it the reverse; a disturbed society showing symptoms of illness? What are the epidemics of aids, drug abuse, violent antisocial behavior, and child neglect, if not manifestations of a pervasive cultural dis-ease? ) An overgrowth of failed and counterproductive lives chokes our nation, a result of our own abuse of democracy. We bought from our politicians the promise to provide all our citizens with education, health, housing, safety, freedom, retirement security, protection of law, and an endless and conflicting set of "rights". We now feel we can (and therefore should) provide the rest of the world with similar benefits. We paid in advance by giving government increased power over our lives. Now we are angry because they can't keep the promises. (Caveat emptor.) Many cultures have something to show us in this regard, not the least of which is that of China, whose people are no less egocentric, xenophobic and haughty than we. Let's ask ourselves why we are instinctively certain what the Chinese should have done at Tiennamen Square, when we know so little of China, what Chileans should have done with Allende, and Iraqis should do with Hussein. How is it that our certainty is inversely proportional to our knowledge? We are able to resolve these tough questions involving millions of foreigners, but can't decide how to punish one famous murderer after many months in court. Where International Health, (which usually can be read Illness), is concerned, we would do well to be cautious in preaching to others, when we still have much to learn ourselves.

Nonetheless, as individuals, English speakers remain in an enviable position among the world's people. Our native tongue has become the functional language for the earth's coexistent worlds. A Japanese tourist or pilot or business person in Brazil will use English to speak with an Arabic counterpart. Furthermore we are a nation of cultures; while we haven't resolved all the problems attendant to this condition, we know more about cultural diversity than almost any other people. Many of us have some family or personal connection to another land, or culture, for ours is still basically a nation of immigrants. This is our strength! Physicians are not excepted from the advantages of language and cultural diversity; and for the moment at least, we have a technologic advantage; particularly where disease treatment is concerned we are experts. The accomplishments of "American" medicine and medical technology are highly regarded. There is, therefore, both a need and an opportunity for physicians to work in other countries. As in most such encounters between worlds, we can both contribute and learn a great deal.

This issue of Sacramento Medicine is devoted to international medicine. Our contributors have been involved in some international aspect of medical practice. Marc Schenker is professor and chair of the Department of Community and International Health at U C Davis, and writes on agricultural health and safety. John McCarthy reports on the recent International Harm Reduction Conference in Tasmania. David Root writes of his experience in Russia, with radiation related illness. Our profession faces significant, some would say cataclysmic, change in the way we practice, driven by economic and political forces. My own father, a mining engineer, graduating in 1929 and finding no work in our country, went to Canada, the Philippines, and Mexico. He and his family were culturally enriched by that necessity. It may be helpful to keep in mind that we, as North American physicians, have many worlds open to us. There is more than one opportunity out there, in a mad cow type disguise.