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A discussion with Jim Kim and Paul Farmer

The Road to Higher Global Aspirations

By Anudari Zorigtbaatar and Ellie Moeller

“My parents were both war refugees. They came to the United States in the early 1950’s when there were probably three or four hundred Koreans in all of the United States. They were in New York City, they studied, and their aspirations were raised for themselves and for their children. They saw: my god, this is what’s possible. And coming from war-torn Korea it was a revelation. They were among a few hundred Koreans that had their aspirations raised by seeing what the US was like in the 1950’s,” said Dr. Jim Kim Yong.

To Kim, his parent’s past is a reflection of the future. As the past president of the World Bank and co-founder of Partners in Health, he sees the expanding aspirations of people around the globe as both inevitable and necessary. The “revelation” his parents experienced in the 1950’s in New York was not a thing of the past reserved for the lucky few. Rather, it is something quickening, growing, and intensifying, riding the tide of market forces.

He explained that what his parents experienced “is going to happen to all 7.5 billion people in the next five to ten years. Everyone is going to have access to a smartphone… and at that point, everyone will know how everyone else lives.” As Kim describes, people will know that the condition they have is one that they shouldn’t die from, or that it is a condition that is treatable, and that surgery should be available. This knowledge will magnify the global desire for better lives that include, among other things, better healthcare for all. Kim believes the movement towards strong healthcare systems is therefore in the hands of the people.

So, what do we do amidst this rise of ambition? What is the role of the surgeon, obstetrician, and anesthesiologist? Kim says to get ready. We must develop robust models for how surgery can be accessed by the 5 billion people worldwide who currently don’t have access to safe, affordable and timely surgical care. These models include plans to provide care for billions, such as development of National Surgical, Obstetrical, and Anesthesia Plans (NSOAPs).

However, models and plans are not enough to achieve this goal. Kim emphasized the importance of innovative financing mechanisms to make these plans a reality. On that note, he can see the similarity between the current challenges faced by the global surgery community and the HIV/AIDS movement. Paul Farmer, co-founder of Partners in Health and one of the pioneers in global health, added the importance of a complementary vision rather than an evolutionary one between these two movements. “Infectious disease doctors and surgeons, we are all on the same team. Instead of debating which one is more neglected, we need to look at the bigger picture where all investment in health, evidence-based investment, are important,” said Farmer.

And to those skeptical of the feasibility of implementing safe, affordable and timely surgical systems in low-resource settings, Kim is eager to respond. He explained that people who claim that “‘We can do a lot, but we can’t do surgery’ is like… drawing a line in the sand.” He rejected this challenge, pointing to surgery, obstetric and anesthesia systems that are already implemented in places like Rwanda. To those wanting to push for surgical care in low-resource settings, he urged us to not be deterred by the line skeptics have drawn: “Don’t think you just want to put your toe over that line. Jump completely in.”

How can we ensure a world that lives up to the aspirations of the global community? Kim said, without hesitation, that investing in human capital is the solution if countries want to compete in the future economy and provide what the citizens demand. Kim said, “What happened to my parents should happen to everybody in the world. Can we make it work for everyone? We have to.”

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