NOW WHAT?!” IS THE LINGERING QUESTION BY
Relief workers and Haitians as the acute phase of the earthquake disaster evolves into the chronic stages of rebuilding. As with the rest of its institutions, the Haitian health care system has been shattered. It functions only through the voluntary efforts by medical teams from around the world. “Now what?” is also the question with which policy makers are now struggling—how to best use the donations from around the world without creating further dependence on aid and stifling local initiative. As governments and nongovernmental organizations gather in the coming months at conferences to debate next steps, they should not overlook a relatively new participant on the global stage—the proliferation of universitybased global health programs. When considering resuscitating the medical system in Haiti, there is a readily available approach that practices reciprocal and sustainable engagement—the model of academic medicine. The scales of these programs vary, but their demographics share a few common denominators. They are sustainable in that they have a big enough talent pool to provide continuous, long-term engagement with partners. They are also reciprocal because academia has a well-worn path for professional groups to collaborate on projects and to create partnerships. Academic leaders who promulgate such programs understand investment in education and systems development, and the programs can provide outstanding patient care along the way. To date, many of these initiatives have been exclusively private or university grant-supported enterprises. However, the scope of the disaster in Haiti necessitates an initiative on a scale that can only be funded with large scale or government support. Funding for such programs to date has been limited to few governmental agencies, and it has been difficult to find backers in a time of budgetary constraint. But when viewed through the prism of diplomacy, such an endeavor—whether under the Department of State, the Department of Defense, or the National Institutes of Health— could serve a broader government mandate in the service of global health. A closer partnership between academic medicine and foreign policy could serve as a model for US diplomatic engagement worldwide. There is precedent for this. The US State Department has a long history of tapping into the best and brightest talent from the United States to promote diplomacy. Such grant-funded programs include musical performances, English-language initiatives, and sports team tours. The strategy is predicated on the premise that individuals will transcend politics to connect through the arts, music, and sportsmanship, and find mutual wellness, respect, and goodwill in return. By logical extension, medicine should be part of this list. By extending its mandate to include international medical outreach, the US diplomatic service could reap the benefits of engaging a talent pool of thousands of physicianambassadors whose goals overlap their own at the professional level, to foster reciprocal goodwill with US colleagues and, at the humanitarian level, to showcase US concern for the well-being of people in each country in which such a program is undertaken. Even before the Haitian earthquake, many advocated for an increased government role in supporting US health care abroad, even to the point of establishing a formal “Global Health Service Corps.” The case for such a program is strategically sound, and provides much needed resources to help improve health in the developing world. However, these programs will take considerable resources and necessitate steadfast leadership at the highest levels of government. Until such a commitment is made, private sector medical teams already providing local medical engagement should be bolstered through grant support and perhaps even educational loan forgiveness. Universities are well poised to have a larger role in global health. They are independent, are charged with promoting the public welfare, and have material and human resources to partner with institutions around the world. Some academic skeptics suspect that such government-backed practices will invite manipulation. They cite the Cuban national health care model as an example, in which the “Health of the individual [is] a metaphor for the health of the body politic.” However, the Cuban government operates arguably the largest medical school in the world with a welldeveloped practice of training graduates explicitly for overseas work, engendering tremendous goodwill abroad in the process.
