Impressions of the Indiana Global Health Research Conference: an editor's account.

As the editor for this supplement, I drove down from Milwaukee to the meeting in Turkey Run State Park, located west of Indianapolis, and participated in the small groups and conducted interviews with various participants. Interviewees were either nominated by the meeting organizers, were presenters at the meeting or were selected by happenstance during the process of attending the meeting. As editor, I also reviewed all the supplement articles. I am not personally involved in global health research and came to the meeting with mixed feelings. On the one hand, I fully understand the allure of “going far foreign and seeing new countries.” After residency, my initial 3-year tour of duty as an Army Captain was in Nuremburg, Germany. Later, while stationed at Walter Reed, I frequently served as “trip doctor” for congressional delegations, and whenever possible, tried to speak with local providers about their healthcare systems. I’ve published articles contrasting the American healthcare system with the German and Dutch systems, and have served as visiting Professor to the Otowa Clinic in Kyoto Japan on two different occasions. In these travels, I have seen a wide range of healthcare systems, from extremely high-functioning to extremely dysfunctional ones. The disparity in health and healthcare systems between resource-poor and resource-rich countries is striking; the need and opportunity to make a significant and lasting difference is real. The instinct to serve is strong in many physicians, myself included. On the other hand, a part of me is honestly isolationistic and even embarrassed about U.S. interventions in health internationally. How can American healthcare organizations justify trying to improve health care in other countries when there is no shortage of problems and disparities here in the United States? In advance of the meeting I was also concerned that, however wellintended, interference by western organizations in lowincome countries could have unintended consequences. In one of my own expeditions abroad, providers in Rwanda had complained that there was money for “sexy” diseases, such as HIV, but no money for other important problems such as diabetes and hypertension. They felt the care they provided and their healthcare system was being distorted by well-meaning international organizations. To be frank, then, I attended the meeting with some predispositions to contrarian notions, personal biases, and frank skepticism. Perhaps as a consequence, I challenged each person I interviewed with tough questions. An initial question asked of all interviewees regarded their personal motivation to be involved in global health. Perhaps not surprisingly, there was some reticence to speak of this, perhaps born of a reluctance to speak of “self.” In the end, however, all respondents observed that upon reflection, medicine is, at its essence, altruistic and should be based on commitment to service. They all reported being strongly motivated by a desire to “do good” and to serve one’s fellow human beings. They also echoed my feelings of feeling appalled at the extreme disparities in health care between resource-rich and resource-poor countries. Many spoke of prior experiences in the Peace Corps or in missionary work. Service to mankind was a universal motivator among my interviewees. “What really grabbed me with this idea was that in these incredibly underserved and impoverished populations, with the right kind of intervention you could really make a huge difference in the lives of larger groups of people. Something as simple as a literacy program for women and children actually changes lives.” Other motivations were a commitment to cross-cultural environments, health development as peacemaking, and recognition that some specific scientific resources (e.g. genomic diversity, certain endemic diseases) are present in LMIC (Low and Middle Income Country) environments. Another tough question was how they could justify working on global health issues when there were so many problems at home. “Before we started thinking about primary care in a global sense, we worked hard to provide Published online June 25, 2013 JGIM