This was a letter Karl wrote to Sue and Will, the health care practitioners he worked with in Guatemala in 2005.

Sorry this took so long, I just got through another set of really hard tests, and I was studying round the clock. Yes, the semester goes… it has its ups and downs like any roller coaster ride, but the classes and information are really interesting and in the end that makes it worth it. Because we are foreign grads there is a lot of talk about how to get back into the States system. Clinicals first, then residency… people to know, places to go, politics to play… its rather depressing at times, and so I started thinking… I haven’t completely thought this out and so I am sure it has a lot of holes and will change a lot, but hopefully the under ridding theme is something workable…

I want to change health care internationally. Working in this field back in the States with as many arrogant doctors as there are is not very appealing to me. I want to make a difference where a difference needs to be made. The way I see it there are a few major problems with health care worldwide. First, the third world doesn’t have any. Second, there is too large of a gap between doctors from the states and doctors from everywhere else. It is incredible to me that doctors from Europe and Canada sometimes need one or two other jobs to support their families. Then of course there is the perceived “do no wrong” reputation and prestige that doctors from the States have somehow cornered.

Obviously there are certain things that will not be able to be changed. Doctors from the states will not give up there precious salary. And changing their reputation will require a large paradigm shift of the entire world. But instead of dragging doctors from the states down, we can build up all the other programs. I was thinking about an international licensing. This would show that all the programs worldwide are equal because all of the doctors have the same test to pass. Perhaps this could also lend itself to the reputation problem since technically all doctors would then be on the same level.

However, this could lead to some problems. Technically doctors from all over could then go to the United States and be licensed to practice. Obvious economic problems ensue. Also, even though this has the potential for schools to want to improve their programs, there is no guarantee that they will want to. Perhaps some places will not care about getting there doctors licensed worldwide. It might even be a detriment to keeping doctors in the third world. Of course this doesn’t even begin to touch the subject of having the ability to improve programs. I’m not sure exactly how deep the capacity of the World Health Organization goes, but I thought that it may be possible to get them involved. I think the simplistic answer is to increase accessibility while still maintaining the quality of medical programs in the third world to increase the number of doctors without decreasing value to the people. Without indepth knowledge of the medical school programs of different areas, it’s hard to comment intelligently, but perhaps government subsidies to encourage students toward medicine.

Or perhaps that is too far fetched due to financial constraints. Then perhaps it would be possible to create an infrastructure similar to what you are doing, but on a larger scale. Would it be possible to teach teachers? Would it be possible to find people, foreign or native, who are taught by someone to be teachers of health promoters instead of health promoters themselves. One person teaches 20-30 people to each 20 health promoters. Not as intimate of a group and of course problems would arise, (dialect differences, difficulties teaching diseases for specific areas, etc.) but perhaps the amount of people of people affected would make the effort worth it…

I don’t know, perhaps I have digressed through this tirade and the whole system, whether improving medical schools abroad or teaching health promoters for the backcountry, would require funding and organization that would be too much to get together. As I said, I just started brainstorming on this, so bare with me. However, I am anxious to hear any and all thoughts and comments on my crazy ideas…

I still enjoy the quarter reports. Somehow I feel it keeps me in touch with a little part of my past that I never want to forget. As always, I look forward to hearing how the intricacies of life down there go…

Carlos