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Year : 2008  |  Volume : 21  |  Issue : 2  |  Page : 237

Suffering and Healing in America: An American Doctor's View from Outside

Book and Electronic Media Review Editor EfH, USA

Date of Web Publication12-Jan-2013

Correspondence Address:
J A Gravdal
1775 Dempster St., Park Ridge, IL 60068
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How to cite this article:
Gravdal J A. Suffering and Healing in America: An American Doctor's View from Outside. Educ Health 2008;21:237

How to cite this URL:
Gravdal J A. Suffering and Healing in America: An American Doctor's View from Outside. Educ Health [serial online] 2008 [cited 2022 Aug 15];21:237. Available from:

Suffering and Healing in America: An American Doctor's View from Outside

Raymond Downing

Radcliffe Publishing Ltd, Oxford (2006) 121 pp., ISBN 1-84619-130-0


Raymond Downing practiced medicine in Africa for a decade. The contrast between healthcare in the United States of America and in Africa motivated him to pen his personal reflections in a series of essays. Ultimately, his Department Chair, Dr. Greg Blake, challenged him to address this question: "what did my African experience have to say about American healthcare?"


Dr. Downing covers the themes of health, suffering, healing, prevention and culture. He begins his introduction with the story of his father who never learned to swallow pills (which is to say, he never fully accepted the tenets of American healthcare). From this personal and local story, he moves to his experience in Africa. He helps the reader understand the perspective of one who has gone out, has come back and sees with new eyes.

Content Quality

The themes of this book are illustrated with stories, all well told. Downing is a student of the humanities, and he encourages further learning. One example is the introduction of the reader to the powerful writings of Ayi Kwei Armah and Cheikh Hamidon Kane.

Several chapters explore "Health." The first asks what most contributes to health. The reader must consider where healthcare priorities are and should be. "Paradigms," explores how the prevailing paradigms of intrusion and balance impact healthcare beliefs and actions. The third chapter," "Hubris," reminds us of the lessons of Aescalapius, Promethius, and the largely forgotten Charon. The final chapter, "Ethics," explores the conundrums that result when ethical dilemmas and decisions are co-opted by legal interpretations and interventions.

The section on "Suffering" begins with a chapter exploring the question of physician-assisted suicide. Downing discusses the difference between pain and suffering. He defines suffering as how one bears physical, emotional and spiritual pain and argues that one of the tasks of medicine is to be with those who suffer. The first of two Chronic Disease chapters explores how physicians disagree. Medicine has evolved from clinical diagnosis to symptom relief to impacting the morbidity and mortality of chronic diseases, but the quantitative impact of our preventive strategies and the resultant dependence they foster on the "medical system" must be critically questioned for both the "Third World" and the "First World." The second Chronic Disease chapter explores Downing's observation "that the search for magic bullets is upstaging the attempts to treat the sickness of society" (p. 55). He challenges us to consider, in context, what Thabo Mbeki said about HIV in 2000 (for which he was dismissively criticized) - that an organism or an etiology is but one small part of the challenge of disease.
"Treatment," "Healing" and "Family Medicine" are the chapters in the section on "Healing." In "Treatment," Downing raises questions of cost and what money can buy. The goal of wholeness as opposed to the goal of cure is the subject of "Healing." Wholeness is sought relentlessly even though healing is not within the purview of mere mortals. "Family Medicine" reflects on this American specialty of the 60's. He argues that the specialty is confronting a number of crises: identity (who Family Physicians are), vision (what they do), financial (how they'll get paid and control costs), methodological (how the discipline "knows"), and ethical (how they relate). This is a strong critique, and I would argue that the crises described apply not only to Family Medicine, not simply to primary care and not solely to American medicine.

In the next section, Downing first discusses the medicalization of prevention. He then takes a look at the examples of malaria, HIV and heart disease so that the reader can consider the complex issues of disease control efforts in opposition to eradication strategies and physician efforts in contrast to health system endeavors.

In the final section, "Culture," the first chapter reminds us that we can't really see our own culture until we stand outside of it. The chapter on "Learning," teaches the reader that 'international health' must be a two way street. The 'first world' cannot save the 'third world,' but we can learn much from one another. The final chapter is entitled "Poverty." Dr. Downing sees the world through a Christian lens which may bother some readers, but the important lesson - that everyone has something to give, has something to teach, and has value equal to anyone else - transcends any single faith tradition.


This series of essays, bolstered by stories, takes us on a delightfully meandering path. The book is generally well written and well organized.


The obvious audience is physicians who labor in the fields of American healthcare, yet this modest and powerful collection of essays speaks to a broader audience. The world has become multicultural and international, and Downing's reflections have both particular and global significance. He provides a springboard from which to dive into waters of thought and discussion which will expand perspective, challenge paradigm and reinforce commitment to better healthcare for all people.

He writes, "all of us need a view from outside," and this is particularly apropos of students and teachers in healthcare. The subculture of medical education should wrestle with the very important and difficult issues that Downing sets before us. This book would be an appropriate and valuable addition to a medical student or resident's "required reading list."

Reviewed by:

Judith A. Gravdal, MD

Book and Electronic Media Review Editor EfH

Morris M. Goldberg Chair, Department of Family Medicine

Program Director, Family Medicine Residency

Advocate Lutheran General Hospital, USA


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