“What are you going to do next?”

These words echoed in his mind as he sat on the shockingly heavy eucalyptus-wood chair in his room.

He wrestled with this question well into the night.

He had not been in a real bed for 42 hours — the thin foam mattress in his guest room didn’t count – and hadn’t showered since the business lounge in Heathrow on his layover. There was a shower in the guest room, but he was frozen in place, unable to do anything. Besides, it had been cloudy most of the afternoon, so the water coming from the homemade solar hot water tank on the roof was only barley warm. He couldn’t get the faces out of his head, replaying them over and over in his mind.

The woman who walked past him with a massive cluster of green bananas on her head, a basket on top of that. When she passed, he noticed a sleeping baby strapped to her back with a wide band of fabric that matched her skirt. He saw her as he left the hospital compound, heading back to his one-room guest house.

The boy in the tattered shirt that could be considered nothing other than ‘dirt-colored’, the same rusty hue as the soil. He had been sitting on a bench outside the surgical ward – apparently not a patient himself but seemed to be caring for a younger sibling. Anywhere else in the world, they would admit the older boy to a severe malnourishment program, yet here he was the healthy one.

The mother of the child who they could not save. She came into the OR to see her son when Dr. Tom went to tell her they had done all they could, but the damage to his internal organs was too severe. She wore a t-shirt from a fundraising run in Texas, worn almost through, and a piece of previously colorful fabric wrapped around her waist. The mother didn’t cry, did not even touch the boy. She approached his now lifeless body. She stood next to her son for a moment, turned, and left.

“They have no idea,” he kept thinking to himself. “No idea what the real world is like. They don’t even know how crappy their lives are. All of them speak only their local language, and most of them can’t even read that. No one has internet, no television, no radio – they don’t even have electricity. Not only do they not know who just won the World Series, they don’t even know who won World War II.”

Seth only knew this because of an interaction that involved one of the sterilization nurses. He was an older man wearing light blue scrubs with the stamp “Property of St Joseph’s” just visible on the pocket. The man had sewn his name with capital letters of red thread onto a white patch of cloth that made it appear as though he could barely write his own name. Printed there for all to see: Adolf. The first time that Adolf approached the OR table and Seth noticed him, he looked across the open belly he and Dr. Tom had their hands in and caught his eye.

“Really?” was all Seth said.

“What?” was Dr. Tom’s characteristically simple response, without looking up.

“The man’s name. Surely he is not old enough … that he was born before 1940” he said, careful not to say “Adolf” or even “World War Two.” In case anyone – especially Adolf – recognized any English words and realized the two white surgeons were talking about him while they operated.

“This place was a colony but not of any strategic importance to the war… or to the world. So it never really affected them. Many people have little education, and even if they do, world history is not given much attention. There’s a good chance that his parents had never heard of Hitler, and there’s a decent chance he hasn’t either.”

Then, without explanation, Dr. Tom turned to the man and spoke. “Adolf…” he started, followed by the peculiar rhythm of their local dialect. To Seth, it sounded like a cryptic sequence of consonant-vowel-consonant-vowel – that he felt he could make up himself. The man responded in a way that seemed so characteristic here, low, quiet voice, no eye contact. After some back and forth, Dr. Tom switched back to English so abruptly that Seth almost missed that Tom now spoke to him.

“He had three years of school before he dropped out to support his family after his father was killed in the civil war,” he said so matter-of-factly that you would think he spoke of who his dentist was. “He said he heard there was a big war between the Europeans before he was born, and it had to do with a genocide, but that’s all he’s ever learned about it.”

That’s when it hit Seth how isolated these people, and now he, really were. One day ago his first thought would have been ‘what is this uneducated man doing in the OR?’ Now he was overcome with not just being in another country, or a culture far beyond the ones he was comfortable in, but a part of the world that was something he never imagined still existed. He was struck with the image of the village in the Asterix comic books he -and every other child who grew up in France – loved so much. One small village at the far corner of the Roman empire the last location not part of the reality of everyone else. This place was like some kind of lost tribe deep in the heart of Africa, essentially untouched by the rest of the world – for all its evil and its good.

They finally walked away from the hospital after a day like Seth had never known. It wasn’t the sheer length of the work, Seth had of course done his time as a surgical resident. As part of his training he knew what it was like to put in unimaginably long days, be on call during the night, and everything else that went with it. That phase of becoming a surgeon which often seemed little more than proving you could keep going. But no surgeon in any developed country would ever have cases so completely unrelated to each other, or so far outside their expertise. Dr. Tom would at one point be repairing a broken femur on a 12-year-old with a stainless-steel rod. Dr. Tom made the rods in his workshop, as he found that he could buy the metal directly from the manufacturer and save a lot of money by cutting and shaping them himself. The next case was a c-section, followed by more trauma from the night before, patients who didn’t come right away as they lacked funds. Then he did an endoscopy on a 50-year-old man, followed by a skin graft on a child whose epilepsy caused him to fall into his family’s cooking fire. The diversity was so shocking that Seth couldn’t help but think back home it would be malpractice for one person to do them all.