Ten Commandments of Working in Low Resource Settings

I recently attended the Widows and Orphans annual banquet which is a 165 year old medical society in Charleston, SC. The guest speaker was Rudolph Rustin, MD who recently completed 1 1/2 years working in a hospital in Rwanda.  Although Dr. Rustin is not an ophthalmologist, I would like to share with you his 10 suggestions for working as a physician in a developing country.

Ten Commandments of Working in Low Resource Settings by Rudolph Rustin, MD, FACS, FASRS  2014-2015

  1. Concentrate on the youth, for they are the most likely to listen, learn, and implement institutional reforms necessary on a grand scale in the future. Have faith. Faith outperforms hope.
  2. It is not about you! However the most valuable asset you have is your ability to positively affect others with your talents. Your impact on others will far outlast your possessions that will all rot with time.
  3. Survival is Adaptation -- Avoid personal and institutional " Brain Drain ".
  4. Understand that priorities are not set by you, but by those with whom you are working. Low expectations can easily rule the day.
  5. Time is on no one's side. The impact of any work done may not become observed or palpable for years. You will likely leave no fingerprints. Never abandon yourself.
  6. Sometimes the most formidable obstacles to change are those in power with their own cultural and institutional imprinting. Expect change to be minimal.
  7. "Lines in the Sand" are a constantly moving target.
  8. Develop as many personal and institutional relationships as possible -- networking groups and forming coalitions is critical to success. Find common ground in those who oppose you.
  9. Don't assume hoofbeats mean horses!
  10. Always consider the road not taken as an alternative in achieving whatever goals you set. Consider the arts as a means to free yourself from the concerns of the day and connect to others in a positive manner.

Initial Corollaries

    1. Learn to like / eat goat as a meal!
    2. Avoid wild animals
    3. Avoid driving
    4. Avoid motos
    5. Choose a country with the least corruption possible
    6. Money does not correlate with value.
    7. Understand Fear and Power ( Africa ) Never assume " I'll never be enough"
    8. Understand honor and dishonor. ( Asia ) Find a balance of ego and honor. The western construct of free speech and voicing opinion openly does not uniformly apply in all places.
    9. Don't assume the Embassy can help you. Embassies can help you only in case of war and epidemic illness. They will give you names of lawyers after you are arrested. You alone are the destiny of your soul.
    10. Fabrication of the truth is acceptable in many cultures. This is not personal.

Hope this is useful ----  certainly many good suggestions / insight.                       

Peace, Baxter

Baxter McLendon MD

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