SIOUX FALLS - Where does it hurt? Doctors ask and then go. They chase disasters and epidemics, but more often follow a trail of little note leading around the world from their South Dakota offices.
It's led Dr. Craig Hedges to Vietnam 16 times and Cuba eight times. It's given Dr. Mark Huntington two years' work at 10,000 feet in the Himalayas and less picturesque teaching duties in Africa, East Asia and Albania. It's made Dr. Rif'At Hussain a visiting hero, "the crazy guy with the white hair and beard," when he touches down for plastic surgery in India.
They train others wherever they go, so the work continues when they leave, and they end up doing most of this for one reason.
"Most people who want to become doctors want to help people," said Dr. Patricia Peters at Avera McGreevy Clinic.
State and national agencies keep no count of globetrotting South Dakota doctors. The effort fits the national fabric in which "we as a rich nation need to be of help when there is incredible need around the world," said Dr. Dan Ostergaard of the Kansas-based American Academy of Family Physicians.
It can be fast work for doctors. Peters sees 80 to 100 patients a week in Sioux Falls. It's 600 to 800 a week in Guatemala. Other times, they wait and improvise.
"You do anything you can do. Sometimes, you just sit and hold babies," Peters said.
They also can run into doubts suggesting it's easy to be good Samaritans as members of a well-paying profession or that the effort might be misplaced.
"There is some skepticism," said Huntington, assistant residency director at the Center for Family Medicine. "I'll often hear people say, 'If you want to help people, you don't have to travel abroad.' That's true. But not everybody can go into these hard places. It's something I can do, so maybe I'm responsible to do it."
Hussain, 66, travels in India to Gorakhpur, a city of mosquitoes and fever that he says smells like a garbage dump. That's a switch from Sioux Falls, where he's lived since 1975 and now works for Sanford Health. But one thing is the same. One in 800 births in both the U.S. and India involves a cleft lip or palate - putting two countries on one level. Word spreads when he arrives. People come on trains or run to his door. He treats children whose parents thought such care was impossible.
"I don't do it for free, but I don't get paid with money," Hussain said.
Dr. Stephen Nanton's homeland, the Caribbean island of St. Vincent, is a new nation making gains in medicine. But it has none of what he is, a gastroenterologist. His work at Avera McKennan Hospital reduces the misery of people with bleeding ulcers or polyps in their intestines. He travels regularly to reduce the misery on St. Vincent as well.
Nanton, 39, trained in Brooklyn and landed in Sioux Falls in 2005. This winter, he led a team back to St. Vincent. Avera doctors gave him $10,000 to help with bills and some staff members came along. Deb White, 49, once wouldn't have imagined such a trip. She drove a school bus for 10 years but trained to become a medical technician. "It's very rewarding to help people," she said.
At McKennan recently, Nanton used a tiny camera to treat a Crohn's disease patient. Matt Daverna, 16, swallowed the camera like a pill. It moved through the system in eight hours, taking pictures and sending images by radio waves. The pill-cam work is a notch above what he can do on St. Vincent, but he hopes soon to import the technology as well.
"We'll change the way medicine has always been done there," he said.
The trail overseas has abundant sources. For Peters, 56, who grew up near Bridgewater, family camping trips as a girl gave her an interest in travel that she couldn't shake. For Hedges, 58, an ear, nose and throat specialist, the source was the Book of Matthew. Jesus healed and taught, so Hedges tries to do the same.
"I can use the gifts God has given me in the profession I practice every day. Numerous people have invested in my education and training. I feel I have an obligation," he said.
Hussain has gone to India yearly since 2008. He first came to the U.S. for postgraduate training and took a liking to "Doc," the Milburn Stone character on "Gunsmoke."
"I always wanted to be Doc," he said. "I go to Gorakhpur and become Doc again. It's a fantastic experience."