In the developing world, education systems are poorly developed or nonexistent. Many peoples are uneducated and carry on with the traditional “cures” they received for generations when they were sick. To maintain good health free from many diseases, good hygiene is necessary—a concept that is also foreign to many in underdeveloped countries.

But even educated people in these countries often have very low expectations of the health care system—they experience cycles of health crises and do not maintain good health. An environment in health care must be created so that these people can also look for care when they need it, and not wait for the situation to become acute or critical. Most of the time these educated mass also do not trust the modern health care system and prefer to be treated by local medicine men. For example, Dhami Jhakri are the Nepalese words for shamans who are local healers and consulted by the local community. They are found in Nepal, parts of India, not only in remote villages but also in cities. Similar mediums, who practice often by spirit possession, are prevalent in other groups and tribes.

Poverty and lack of education, along with other social determinants, are proven barriers to health care. Various measures of health quality, including low life expectancies and high mortality rates, correlate to low levels of education [16]. People living in poverty usually have not been educated as to when, why, and where to access health care. Many mistakenly believe that their affliction is irreversible and permanent or the result of some wrongdoing on their part or the influences of evil spirits, and they are unaware of medical treatments that can treat or cure their condition. Additionally, general public health education is lacking, such as knowledge of proper hygiene and water treatment. It is the role of global health organizations to fill these educational gaps. By training health workers and community members to raise awareness about good health practices and opportunities to access medical care, global health organizations can produce far-reaching positive results.

The developed world needs to be educated and made more aware of poverty-induced health crises across the globe. Though general health education is readily available in affluent countries, education and advocacy about poverty-induced health crises throughout the world are necessary to spur developed nations to action.

Strasser described it well: “Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty–ill health–low productivity downward spiral, particularly in developing countries.” [17]

An earlier paper by Yancey reported “Health care providers are reminded at intervals that rich and poor, educated and illiterate people react similarly to excellent, considerate health services. Practice does not make for perfection in medicine; only excellent practice permits a close approximation to perfection. Poor people know of the presence and accessibility of the public teaching hospital in their community, yet they report to the hospital later than the higher income, private hospital individuals for care” [18]

And finally Clark reporting on volunteers in Ghana wrote: “Even though people are generally poor they still want to preserve their dignity. Valuable/expensive things offered on a silver platter tend to lose their value and have the tendency to be abused. Thus it is always advisable to let people bear some responsibility. This is why some communities have to pay a token fee for some of the services or medications. No matter how meager a fee paid, it is enough to let one value whatever is offered. If something very expensive is being offered for free, the notion is that it is meant to be thrown away; and that is why it is being given to them. They may even feel belittled by the totally free offer.” [19]

Indeed, global health disparities and inequitable access to health care in developing countries should be an ongoing concern for many if not all physicians [20].

Thus evidence and research underscore that education is the key to sustainable changes in developing countries. Bidirectional education between low and high-resource countries can be beneficial to both sides. Low-resource countries gain knowledge, advanced clinical skills, and infrastructure organizing skill to meet their local needs. Students and faculty from high-resource countries also gain medical knowledge, clinical skills, cultural sensitivity, adaptability, flexibility and have more appreciation for public health and socioeconomic factors. The knowledge and experiences gained from working in low-resource countries can have long lasting beneficial effects on their career paths [7, 21, 22].

The World Federation of Societies of Anaesthesiologists (WFSA) has provided training opportunities in many areas around the world, both in-country training programs and overseas training programs. Candidates for oversea training must commit to return home to practice. The main advantage of overseas training program is the opportunity for the trainee to see the system and infrastructure support of anesthesia from the inside. The graduates can use knowledge and experience to organize infrastructures, improve anesthesia practice, and even become professional leaders in their homelands. However, local investments for infrastructure support and continuing education, as well as political commitments are essential to attract physicians and non-physician staff and retain those trained anesthesia providers in the areas of need. Studies reveal barriers to recruitment and retention of anesthesia providers that include poor working environment and limited appeal of health care jobs. These critical issues must be acknowledged and remedied in order to reduce the complex problem of “brain drain” [23]. In low-income and middle-income countries, well trained anesthesia providers, as well as other health care workers are very poorly paid. Thus, they either move to higher paying jobs locally or migrate to better-paid jobs abroad. In the past, the most commonly used strategy to retain those valuable health care personnel was compulsory rural service bonds and mandatory rural service for admission into postgraduate training programs. However, the new strategies including well-balanced workforce management policies, incentives, incremental improvement in public health facilities, better residential infrastructure, and local health care provider recruitment have shown promising impacts [23, 24].