Rick Donlan, an innovative doc among the Memphis indigent, has a talk that he titles "From the 'Hood to the Hindu Kush", which is all about why serving in the American inner city is the perfect training ground for international medical work. One of the facets of his clinics in Memphis is that they take young docs from around the country, bring them to Memphis where they work (and live) among the inner city, get their loans paid off, and (in his words) then send them off to some place real scary.
My family medicine clinic is in Ypsilanti, MI, which is a relatively small outlying area of the greater Detroit area, that has an uncanny inner-city feel, given its size. Thus, some of the points Donlan made were already apparent, but some generated further thought. Overall, I heartily agree that the inner city is a great training ground for international service. Reasons why:
1. Immigrants pool in urban areas: my patients are quite often only speak Spanish, French (West African), Thai, Somali, Arabic, etc.
2. Plenty of experience working in limited-resource scenarios.
3. Both the inner city and communities abroad are very tight-knit and often very large families.
4. Both environments may have quite a bit of mistrust towards outsiders professing to want to help (and often times for historically good reasons).
5. Often the simple answer (hygeine, money for food, education, neglect) trumps the more complicated answers you learn in med school.
6. You have to stretch your mindset to see things from a very different point-of-view.
7. Lastly, there are some people in both places who will defy your categories. Are they wanting help? Do they want to help others? Or are they after something else? Sometimes you just will never know.