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A Piece of My Mind
January 5, 2000

For What Purpose?

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2000;283(1):18-19. doi:10.1001/jama.283.1.18

"What are we doing here?" I wonder aloud. From the top of one of the world's largest slums, all I see is line after line of plywood boards and plastic bags that do not succeed in blocking the tropical rain. Tens of thousands of people live in this "precarious urban zone" of Guatemala City, and there are hundreds of thousands more across the city. What difference will one volunteer physician make?

Though this morning I feel uncertain and somewhat overwhelmed, I know that neither I nor the others in the team usually feel this way. We have all been part of similar missions, and all of us have come back for more. Some of us were first attracted to relief work for the adventure and for the chance to see the "dark side" of the world, but this does not last long. When we're addressing the health needs of an entire population—stemming an epidemic of cholera, or setting up a mass vaccination campaign—there is no question about the value of what we're doing, and our own doubts do not interfere. But when the work has no public health mandate, only the focus of individual patients surrounded by chronic poverty and endemic illness, where does the sense of larger meaning come from?