After previous journeys providing medical assistance to Belize and Ecuador, Dr. Lauri Costello spent two weeks in late March in Kabul. She traveled, she says, "with the Memphis-Afghanistan Friendship Summit, a small outfit out of Memphis, run by a doc and his wife, who's a nurse. He knew a doc in Kabul and established a connection with the Ministry of Health there.
"I am a doc at heart who wants to help people, but who's fed up with the system in the U.S.," says Costello, adding that "a frivolous lawsuit" also contributed to her decision to leave her Spokane practice and seek another position in family medicine internationally.
"For now," she says, "I'm just doing some freelance surgical assisting, just to pay the bills and because I like being in the O.R. I pay my own way to these other countries, just so I don't have to be under some agency."
Costello adds that Malali Hospital, "the main OB-GYN hospital in Kabul, didn't need us. They had 40 young female doctors already there learning obstetrical and gynecological surgical techniques. But the problem is in rural areas, where women are giving birth in dirt huts, and the baby dies of tetanus, and the woman dies of post-partum infection and nobody ever hears about it."
Americans like to give away the high-tech goodies because that's what distinguishes our medical system: feel-good philanthropy. But the needs of the developing world are much more basic, says Costello: "In Central and South America, they need public health. My sense is that with the poorest of the poor in the Third World, they need clean water. Their under-5 mortality is so high -- in Afghanistan it's among the highest in the world. They have parasites all the time. So with all the malaria, TB and intestinal disorders, they need public health and personal hygiene more than they need high-tech medicine."
Costello laments the world's failure to deal with treatable diseases such as malaria, HIV and tuberculosis: "It's a lack of money, sure," she says. "I heard a Western doctor estimate that $34 per person -- for every person who actually has the disease -- we could eradicate TB from the planet. The total was something like $240 million -- or about the amount we spend in Iraq every day."
There's another area, too, in which Americans need to give what the recipients need, not what we want to give them: The developing world, she believes, needs constructive and enabling charity minus the religious proselytizing.
"Because I have a strong faith background, I have a passion to serve the poor," Costello emphasizes. "But I'm not a medical missionary.
"There are a million churches over there. But despite my faith commitment, I don't believe in faith-based Third World health care.
"I talked to a nurse -- this was during her first experience, in Honduras -- and she was skeptical that the churches were doing any good, going for the short term and giving away a lot of free stuff. She said the people would clamor standing in line -- and then, when they ran out of stuff to give away, 'They got mad at us.' It's just a lot of rich Americans who dole out what they have, then leave without establishing any sense of community. The attitude I saw in Central and South America is that we're very arrogant about the things we give away."
Costello prefers the kind of help provided by organizations that "go in for the long term and provide culturally appropriate aid. They build well systems and educate the children."
She's concerned about how our wealth blinds us: "We have everything. And the things we complain about -- 'My brand-new car got a scratch' -- we don't realize how out of touch we are with the needs of the rest of the world.
"The issue of personal integrity, resource use, how we vote, what we drive and how much, what we buy... all speaks to the issue of justice for the poor. I think if people in America were more conscious of trying to live a simpler lifestyle with more compassion, and let their representatives in government know what's important to them, perhaps we can be more compassionate as a nation."
How can we put that compassion into action? "My personal donations go to World Vision," says Costello, "because they teach people to care for themselves.
"Another practical way people can help," says Costello, "is to adopt a child through Compassion International or World Vision -- $30 or so per month to help support community development, including food, clothes and education for the child."
Thinking globally about the ravages of malnutrition and disease is sobering for any of us, and naturally Costello feels overwhelmed sometimes by the enormity of the world's health problems.
"But when I look at one kid or one mom," she says, "I just think to myself, 'I can't fix the whole problem, but I can help this one person.'"