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June 2000

Out of Africa

Arch Surg. 2000;135(6):720. doi:10.1001/archsurg.135.6.720

RECENTLY, I had the opportunity to visit South Africa for 2 weeks as a visiting professor in the Department of Surgery at the University of the Orange Free State in Bloemfontein. This area represents the heart of the original European Dutch settlers (now Afrikaaners), the center of the Boer Republic, and one of the areas where the now-hated apartheid movement originated. I found a country dismantling the apartheid regime and struggling with the many new concerns of both the government and the health care providers—how to nationally integrate the very poor and vast areas of this country now functioning as a Third World nation with other less prevalent areas of considerable wealth functioning as a First World nation. Spending only 8 working days there, I fully acknowledge that I received but a glimpse of the true country (and that largely was from the specter of a First World university department of surgery). I found a university medical faculty involved in undergraduate medical student and postgraduate training facing many problems—a bankrupt provincial government (hopefully only for 1 more month), a university hospital closed except for emergencies or life-threatening conditions, a government-directed attempt to deliver health care on a district basis rather than via the previous secondary and/or tertiary care system that had been operational until that time, and the charge to develop a medical training program that would be efficient and appropriate for doctors to treat the problems indigenous to a Third World country (many of whose citizens lack running water and internal plumbing, let alone health care insurance programs for screening mammography, prenatal care, etc). Despite these seemingly overwhelming obstacles (with more undoubtedly to come), I found an obstinate (Boer-like I understand), focused faculty dedicated to developing a new curriculum for 5-year combined university/medical school training designed to maximize efficiency and minimize costs. This new curriculum is designed to produce physicians able to deal with the problems of a Third World country—advanced malignancies, the ravages of human immunodeficiency virus disease, trauma, violent crime, and the lack of even the basics of preventative medicine in many rural areas. The mission of these educators differs immensely from much of surgery's ivory tower approach; yet, their mission is very real and a no less important one for their country.

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