Kudos on Monique Tello’s Letter from Guatemala [“Eyes Wide Open,” Summer 2002]. It was well written and moving and probably similar to the experience of many medical students rotating outside of the industrialized world, where the “brutal social dichotomy” does indeed exist.

As for the challenge for the rest of us to “fight complacency, to open the closed and contented mind,” many learned and well-meaning social crusaders have tried and failed miserably, being accused of American imperialism, cultural genocide and worse. For an example of the pitfalls inherent in this kind of work, read Death Without Weeping: The Violence of Everyday Life in Brazil about a California social worker who attempted to improve literacy and vaccination among Brazilian children at her own expense and was rewarded with continued expulsions from the country on the grounds of subversive activity.

Sometimes changing the political landscape must precede humanitarian efforts. For this we must look to our political science colleagues for guidance—and hope.

Susan M. Richman, M.D., HS ’83
Guilford, Conn.
The writer is an assistant professor of obstetrics and gynecology and director of the Women’s Center at Yale-New Haven Hospital.