Lessons from a Cartogram

As I look back over my high school days, I can’t say that the subject of geography holds a special place in my heart.  I don’t remember who taught it, I don’t remember what grade I was in, and I certainly don’t remember any of the subject matter.  But I was recently introduced to a website that uses an item as simple as a map to present statistical information in a remarkable manner.  Though its data are a few years old,  www.worldmapper.org presents a vast array of cartograms that may just give you a new perspective on the world, on the priorities and struggles of its citizens, and on life in general.

So what on earth is a “cartogram?”  It is defined as “a presentation of statistical data in geographical distribution on a map.”  Let me try to explain.  First, take a look at the map below.  It is your typical land map, with each country drawn according to its land area.  All of us have seen this type of map in one textbook or another.

Now suppose that we want to study a particular variable and compare it across countries, such as fuel usage or infant mortality or adult literacy.  A cartogram shows a map of the world such that the size of the country is scaled (increased or decreased) in relation to other countries depending on the value of the particular variable of interest.  Perhaps it is best to just learn by example.  In the map below, the variable of interest is passenger cars.  It is no big surprise that the U.S., Europe, and Japan have the majority of the vehicles.

Let’s look at another one.  The map below shows childhood mortality for ages 1-4 years.  As you can clearly see, those born in Africa and India face the greatest challenge of reaching their fifth birthday, while such a dilemma is virtually non-existent in the Americas and Europe.

As a physician, the map that grabbed my attention the most is the one below showing the numbers of practicing doctors … and bear in mind the tremendous contradistinction of Africa in the maps above and below.  Africa, overwhelmed by childhood mortality, simply has very few physicians to address the demands.

As we see the continent of Africa sink into the depths of the ocean on the map above, I think a few points are worth considering.  In looking at all of the other cartograms, there are clearly groups of countries that have and groups of countries that have not.  Yet it is not only the overwhelming scarcity of physicians on the continent of Africa that strikes me, but also the relative isolation in which Africa endures this phenomenon in comparison to other continents.  Alone on a map, but not forgotten by our God.

In my own specialty, there 9000 urologists for just over 300 million citizens in the US.  In Africa, there are approximately 400 urologists for 1 billion people.  If you remove the country of south africa, you have about 250 urologists for 950 million.  Therefore, a realistic assessment is that most of Africa has 1 urologist for every 4 million people.  To put that into perspective, my home city (Atlanta) has roughly 100 urologists.  If Atlanta were equivalent to Africa in this regard, it would be served by only 1 or 2 urologists.

Human logic would suggest that the need is too great and the workers are too few to bring about any substantial change.  Fortunately, we serve a God whose objectives are beyond the confines of human reason and whose means to reach those objectives are fueled by His power and now ours.

The Pan-African Academy of Christian Surgeons (PAACS), a Christian based general surgery training program, has a stated goal of changing the healthcare of an entire continent.  This is a bold and ambitious intention, to say the least, but didn’t a few loaves and fish feed the thousands?  Through our ministry with WGM, I will be blessed to have the opportunity to train general surgeons in the field of urology, which accounts for about 20% of the surgical case load in developing countries.  Their model exemplifies God’s principle of multiplication.  For instance, if each of the eight PAACS hospitals could be staffed by a urologist year round, and if each of the facilities graduated two general surgeons annually who were skilled in basic urologic surgery, then in just fifteen years the number of urologically trained surgeons in Africa (excluding South Africa) would DOUBLE.  Unfortunately, none of these PAACS facilities have a full-time urologist.  Of note, there are at least eight more hospitals interested in becoming PAACS training centers, if only there were more physicians available to provide training!

Jesus said that the workers are few, and this certainly applies to the numbers who are training Christian surgeons in Africa.  But I believe that in these very times God is calling out for Christian physicians to join Him in this work.  And as they answer the call, one by one, we will continue to witness His economy of multiplication, and perhaps we will in fact see a change in the healthcare of an entire continent.