Commentary: Academic surgery and global health.

For low and middle countries, the local surgeons and physicians should dictate, direct, and deliver the care for their people; therefore, their priorities are paramount. We have an opportunity to help, advise, and support their efforts and perhaps enable improvements in the timely delivery of basic care. Although we cannot ‘‘fix’’ their problems, we do have the opportunity to partner with our colleagues as we seek to address disparities and improve access and care broadly and globally. We must, however, focus on sustainability. Dr Calland has highlighted the current climate, the threats to academic development, disincentives to academic and clinical departments, and disincentives to the individual surgeon, including educational indebtedness, but also the rewarding opportunities. Noting that ‘‘all politics is local,’’ there will likely be individual decisions, arrangements, and compromises for the short term. Most specialties in the now ‘‘Balkanized’’ discipline of general surgery started out as ‘‘interest’’ foci. The academic track for global surgery seems to be on that samepath.We can ask with Dr Nwariaku ‘‘Where to go from here?’’ The encouraging factors are that this quest is important; there is a very definite sense of perceived need, exceptional colleagues are already on the journey, and probably MOST IMPORTANT OF ALL---our younger generation WANTS to participate.