When I recall my time studying medicine overseas, in India, the Dominican Republic, and Mexico, what I remember are the vivid faces. Of patients, yes, but the ones that stand out most are the faces of my colleagues: the animated laugh of the man who runs a disease surveillance lab in the Dominican Republic, who taught me about malaria. The serious expression on my fellow medical student Brahma’s face as he translated for me on the wards, guiding my hand as I palpated a woman’s tumor. The tears in my friend Marisela’s eyes as she tells me how a patient of hers died in her arms after a car accident because her hospital had run out of blood. Having learned so much from them, I ask if there is anything I can do in return. Almost all of these young doctors give the same answer: ‘give me the books you used to study for the U.S. Medical Licensing Exam.’ Rather than remain in their countries, the dream for most is to emigrate to the U.S., or to Europe, as quickly as possible.

Part of me judges: Shouldn’t you stay here, take care of your people? I can put up with cold showers for a summer, can’t you? While some of my friends mention money, for most they seek to practice medicine in the U.S. for reasons beyond creature comforts. They are faced with the terrible conundrum of realizing that like me, they receive excellent medical training, but unlike me, their hands are often tied: they lack medicines, supplies, facilities, sometimes even electricity or clean water. They have the knowledge to recognize the illness but not the means to impart the cure. It might seem a waste to a nation to me, to have trained a physician whose main goal is to leave, but I morally can’t ask someone to do something I won’t do myself. I am not poring over yellowing copies of JAMA in a dank medical school library, by flashlight when the power is out, wondering if I will ever get the opportunity to employ the treatments described therein. I am not wringing blood out of old sheets between surgeries. I am not choosing which of my patients gets the last vial of antibiotic. I too could get used to sweltering wards, third – hand textbooks, stepping over patients on my way to work because of overcrowding, but I will never face the dilemma my sister’s friend in Uganda described when he elected not to go into pediatrics: ‘I could not stand to watch other children die because their parents couldn’t pay me, and I couldn’t bear to watch my own children starve, because I gave away my services for free.’

What doctors in other countries need to stay are the means to make a decent living, the supplies to allow their patients to get well, or at least to die with dignity, and opportunities to participate in the larger medical community through education and research. And, the United States can supply all the money and all the drugs, but what the U.S. really needs in order to accomplish anything useful overseas are partners. Partners that speak the local language, that have the trust of the local population, that can tell us as outsiders the best way to go about solving problems. The most important thing the United States can do to improve global health in the next fifteen years is to invest in long – term partnerships with medical professionals and institutions overseas. Hundreds of these partnerships already exist on a small scale between universities, churches, and community groups here and abroad. In India, I lived at a hospital envisioned, funded, and built by a cardiologist raised in Hyderabad but who now worked at the University of Pittsburgh. Local people, who previously shunned hospitals as ‘the places where people go to die’ had begun coming in droves once they realized the pharmacy always had drugs, and the operating room lights stayed on. This partnership benefits us too: I went with a team from Pittsburgh to learn about implementing vaccination and safe motherhood campaigns in rural villages. The goal was to start a similar program in a housing project back in Pennsylvania.

Will this strategy entice doctors and other professionals to remain in their own countries? In the words of my colleague in India, Dr. Ravi Himagalore, who trained along with his wife in Chicago but had just returned to Hyderabad: ‘ten years ago I would have stayed away. These opportunities did not exist. Now I can come back, take care of my patients in the way I was trained to do, write research papers. Best of all, I can live near my mother – she watches my daughter while I am at work!’