Bus stop

I met a very interesting person, today.

It was seven in the morning, and the air was bitterly cold as I arrived at the bus stop. My bus was due in ten minutes. The man already standing there with no hat told me that he had been waiting for half an hour, he had given up on the bus he'd come for and was now looking forward to the next.

We got chatting, as people do when they stand for any length of time together in the dark and the cold. We compared notes on this and that, and eventually got around to what we do.

He is a doctor, a GP working in a practice at the other end of two bus routes. That already puts him above me in the scale of things; the world needs doctors more than it needs mathematicians. But as we talked, there was more. He is Senegalese. He trained at the University of California medical school at Davis. He runs a free clinic in Senegal.

Hang on ... wind back a bit ... if he runs a free clinic in West Africa, what is he doing at a bus stop on the western edge of Europe?

He is, I learned, one of several doctors at the clinic. Since free clinics generate no income, and since this one is unfunded, money has to come from somewhere to pay its running costs and to feed the families of the staff (medical and otherwise). So, the doctors take it in turns to take contracts in developed economies. The income from these contracts goes to maintain the clinic, its staff, and their dependents. My bus stop companion is in his sixties and half way through a two year contract, a year away from his family whom he misses desperately and with another year to go.

That this system is able to work depends, of course, on the same asymmetry which makes it necessary: the yawning gulf between first and third world economies. This doctor, and his colleagues, live and work at one end of an economic gravity well where money is scarce so costs and incomes are low. They have found a way to exploit that same gradient, using it to make a first world salary run a clinic, pay operating costs (including salaries), and provide pension provision for old age.

I've seen a fair amount of quiet heroism in the face of third world poverty and health needs. In the field, I've carried bedpans or washed bandages or ... but then I've always scuttled back to my comfortable first world billet. I've supported campaigns to fund third world medicine ... but never for even a day to the extent that this man and his partners do, across whole lifetimes. Any of them could stay permanently in our more comfortable settings, bring their families with them, reap the rewards of the hard work which gained them the qualifications and expertise which they now possess ... but they don't.

I didn't get around to asking where the pump priming finance came from, to put him through a US medical school in the first place. Wherever it came from, though, it wasn't used to buy his way out of hardship; it has been ploughed back over a lifetime into his roots.

Four of the charity links at the top left of this page point to organisations concerned with the third world; two of them are medical; one is dedicated to helping communities meet long term health issues and thus escape a cycle which they can't afford to break on their own. If you have money which you are inclined to donate, any one of those charities (and many more besides) would be a worthy recipient – but, after my bus stop conversation, Health Poverty Action (formerly Health Unlimited) is the one that will get any extra that I have available this festive season. And if you want to combine a lifeline with present giving, they have a selection of ideas starting from as little as US$8/€6/£5 (a contribution to child health monitoring) running up by easy increments ($16/€12/£10, $24/€18/£15...) through a set of surgical instruments ($160/€120/£100) to the top whack installation of a life saving water system ($630/€470/£400).