My brother Dave and I were eating lunch in his tin-roofed house in the Nigerian bush, looking out at the sun-browned patchy grass and gnarled trees, when he said:

"There comes the bush ambulance."He pointed in the distance to six men shouldering a crude stretcher with a cloth-wrapped form on it.

Before I could ask what was going on, Dave was loping down the hill toward the hospital. An hour and a half later he was back, in the green baggy pants and shirt of a surgeon.

"She had been in labor for three days," he said. "Her pelvis was too small to deliver normally. We did a Cesarean, and both mother and baby are okay.

"It took them 12 hours to get her here from their village, but if they hadn't brought her in, she'd have died."

Out of nowhere, I had a lump in my throat. "It must be a great feeling, to save a life like that ... ."

"Frustrating is more like it," he said. "If she'd had a decent diet when she was growing up, she probably wouldn't have had this trouble. And there are so many more like her, who never get brought in."

He talked about the struggle a surgeon had to keep up with preventable injuries.

The Hausa, a nomadic people, sleep outdoors, and on cold nights Hausa mothers lay their lightly dressed babies near the campfire to sleep. Now and then a baby rolls into the flames. Dave, a board-certified surgeon at a well-equipped mission hospital, often did skin grafts on the ones who survived, covering their terrible burns.

"But families that have modified tribal custom, dressing the babies warmly at night in the winter months, don't have to put them so near the fire. The kids don't get burned."

That was 1969, and change was ahead for both of us. I was about to enter the new field of bioethics, and he was about to make the drastic change from surgery to public health - from repairing to preventing the injuries.

Over the years, at widely spaced family reunions, we would talk about his prevention work. Helping people eat better. Teaching them to wear sandals to avoid snakebite. Building latrines to keep the cooking water pure.

We also talked about the way modern medicine, with its welcome miracles, can blind us to what sickness and health are really about. The "less civilized" Third World, it turned out, had as much to teach us about health as we could teach them.

They remember what many of us have forgotten:

- Health involves the whole person: A thousand miles back in the Nigerian bush, and later with Native Americans in the Everglades, Dave came to appreciate the work of the local shamans - medicine men and women.

He referred patients to them, and they sent patients to him. They knew people are more inclined to get sick when their feelings and relationships are troubled. People are more likely to be well when they're in loving relationships and their mind, body and spirit are in harmony.

Dave didn't discount the power of western medicine, but saw that it could be rendered useless or relegated to a game of catch-up if the basic idea of health - wholeness - was continually ignored. It was as true in Baltimore as in Bangkok.

- Good health is a community matter: A movement called "community-based medicine" has been changing the way non-industrial countries look at health problems.

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People of a neighborhood or a village discuss what they see as their most urgent health problems. When there is agreement on priorities, the community attacks the problem itself or, if appropriate, invites in the professionals. This approach sees people as more than passive recipients of "care" that is "given." They are full partners.

- Health is a justice issue. Dave has written: "It is generally accepted that poverty, a result of widespread greed, is the major cause of illness in the world."

A friend told me of meeting a woman in Manila whose little boy had died that day of bronchitis. Yes, bronchitis.

My friend's young daughter, visiting the Philippines with him, had had bronchitis the same day. But she was healthy and well-fed. With antibiotics, she recovered in a few days. But the woman and her son, poor and hungry, had just fled their burning village in a civil war zone. But antibiotics had been futile against the things that killed the little boy: poverty, oppression, alienation and fear.

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