By Ronald M. Davis, MD
American Medical Association, March 17, 2008

In the summer after my junior year in high school, when I was 17 years old, I traveled to Ecuador as part of a Latin American vaccination program called Amigos de las Américas (Friends of the Americas). During my three weeks there, I immunized 500 children against measles.

That experience solidified my interest in a career in medicine and was my first exposure to public health and preventive medicine. But most importantly, it was a great opportunity for personal growth.

Last month I spoke at a luncheon for Amigos in Houston, where the organization is headquartered (www.amigoslink.org). The purpose of the event was to build support for the program among local businesses. My talk gave me a chance to reminisce about my Amigos experience 35 years ago, and to reflect on what the program had taught me.

I remember us driving on unpaved roads, going from one town to the next, up and down hills that became mud slides when it rained. I remember us traveling by mule to reach the more remote villages that were in need of our valuable serum. I remember how grateful parents were when we gave their children a better chance for a long and healthy life.

Sometimes parents brought their children to a clinic to be immunized. But usually, we made house calls, going door to door, block by block.

Many of the young children, of course, would cry when they got their shots. When we immunized the first child in a family, the anxiety would spread to the other children in the household. But after all of them were immunized and their whimpering had ended, they'd follow us to their neighbors' homes to watch, with great delight, when we stuck our needles into the arms of their friends. Soon we had a crowd of kids following us from home to home, creating quite a commotion.

I remember staying with local families that accepted us into their homes with that familiar form of hospitality -- mi casa es su casa (my home is your home). I remember a beautiful family in the town of Paján that put us up in their wooden shack -- with no electricity, no running water and no beds -- but no walls between them and us. They had few material goods, but they had a love of life and a love of family and children that was unsurpassed.

Some of the challenges we faced were important for us -- as American teenagers -- in developing an appreciation of the differences between the haves and the have-nots.

I remember using the outhouse behind my host family's home at night. When I lifted the lid on the seat, and shined my flashlight on it, I saw a seething mass of cockroaches. I remember when my Amigos partner and I bathed in a river at night, using the moonlight for illumination. We picked up the pace of our bath after hearing the noises of the cows sharing the same river, upstream from us.

The good part about experiencing those privations was that when I returned home, my attitudes toward the creature comforts we enjoy had changed for good. I began to see those comforts not as anything essential or important, but as privileges that could be jettisoned without any problem.

Most of all, I remember learning, during my Amigos experience, what's most important about life. Author Robert Byrne put it so well, when he said, "The purpose of life is a life of purpose."

That purpose should not be driven by a thirst for wealth, or power, or fame. But instead, it should aim to lift up humanity, and to ensure that people everywhere can enjoy life, liberty and the pursuit of happiness.

One of my favorite quotes has been attributed to Shirley Chisholm as well as to Marian Wright Edelman. One or both of them said, "Service to others is the rent you pay for your room here on Earth."

The Amigos program, and so many other programs like it, help people pay their rent. But unlike the rent they pay for their housing, this particular rent brings them dividends that enrich them for the rest of their lives. And at the same time, many thousands of people served by these programs benefit immeasurably.

Yes, we have many needy people in the United States, especially the 47 million Americans who lack health insurance. But as the wealthiest nation on Earth, we cannot ignore disadvantaged people throughout the world, particularly those living in low-income countries.

That's one reason that the AMA has a program in international medicine. We work with the World Medical Assn., the 85 national medical associations that are organizational members of the WMA, the World Health Organization and others to address the needs of physicians and our patients globally. Information about the WMA's many policies and programs, and how to become an associate (individual) member of the WMA, can be found on its Web site (www.wma.net).

As stated in the AMA's 2008 Strategic Plan, "Globalization of health care and public health is increasing through such forces as transmission of infectious diseases and pandemic planning, environmental causes of disease, international marketing of pharmaceuticals, cross-country migration of physicians and nurses, and provision at non-domestic sites of medical services such as medical transcription, reading imaging studies and health IT support. This phenomenon requires the AMA to be engaged in international health."

The AMA Web site provides details on the AMA's global initiatives and a list of international health, human rights and relief organizations and volunteering opportunities (www.ama-assn.org/ama/pub/category/3344.html). The AMA has published two volumes on the subject, written by Edward O'Neil Jr., MD: Awakening Hippocrates, a primer on health, poverty and global service; and A Practical Guide to Global Health Service, which offers a database of worldwide volunteer medical opportunities and practical information on volunteer medical service, world travel and cultural issues.

I encourage physicians and medical students to support or participate in health services overseas, and I congratulate those who have already done so.