When I hear somebody sigh, "Life is hard," I am always tempted to ask, "Compared to what?"
- Sydney J. Harris
I recently was privileged to hear Dr. Claire Wendland  describe two groups of medical trainees.
The first was a group of medical students from the United States spending time in the sub-Saharan African country of Malawi . Each day, the students learned from their American professors and African colleagues. The students were surrounded by patients with diseases that they had previously encountered only in textbooks and lectures — malaria, untreated HIV/AIDS, the late stages of tuberculosis. Many patients had very advanced disease or long-neglected illness. The students were immersed in a medical system that relied heavily on improvisation. The medical facilities had inconsistent electricity, limited imaging studies and bare-bones laboratory testing. The students also noted that the Malawi hospital had none of the American obsessions with billing and record keeping.