One day, one of our critical care nurses asked me for help: Her mother had been admitted to a hospital in Nigeria because of heart block. The pacemaker necessary for her survival was unavailable, and no fluoroscopy tubes were functional. Several attempts were made to contact the International Red Cross, the World Health Organization, and Doctors without Borders, but lack of funding or insufficient organization quickly made us realize the helplessness of these associations in solving this emergency. I then called our Medtronic representative and received a free pacemaker unit. To obtain a visa for the patient, a colleague in Lagos sent me a fax stating the patient's medical condition. I submitted this fax to the urgent attention of a U.S. senator, along with a personal affidavit supporting the need for an emergency pacemaker implantation. A few days later, the patient arrived in the United States and was admitted to a local community hospital. At that time, she was lightheaded and had symptoms of congestive heart failure. An electrocardiogram showed a complete heart block with an escape rate of 28 beats/min. The pacemaker unit was delivered to the hospital, where two colleagues, a cardiologist and a surgeon, agreed to implant it free of charge. The patient was discharged in good condition 2 days later.

The saving of this human life raised several questions: Should it be made easier to contact an international organization that would be able or willing to help in similar situations? Should not health care spending be better allocated and redistributed in Third World countries? Should the industrialized nations help in structuring an improved health care system for less privileged countries? Will the more cost-conscious approach of managed care render this kind of generous enterprise impossible? If so, is a human life a cost or a sheer benefit?