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EW NEWS & OPINION 12 August 2014 by David F. Chang, MD been abandoned by their husbands, and that's why they'd gone into prostitution. They were trying to make enough money to feed their kids. They were so low in the eyes of society that they could be raped and robbed and beaten by anybody— even by police—and nobody cared. Later that day, I spent some time in a home for the dying. I walked into a large hall and saw rows and rows of cots. Every cot was attended except for one far off in the corner that no one was going near, so I walked over there. The patient was a woman who seemed to be in her 30s. I could tell she had AIDS, both from the way she looked and the fact that she was off in the corner alone. The stigma of AIDS is vicious—especially for women—and the punishment is abandonment. When I arrived at her cot, I suddenly felt totally helpless. I had absolutely nothing I could offer her. I knew I couldn't save her, but I didn't want her to be alone. Then I had to leave her. But she never left me. I felt completely and totally inadequate in the face of this woman's death. But sometimes it's the people you can't help who inspire you the most. Optimism for me isn't a passive expectation visit to a hospital for patients with multi-drug-resistant tuberculosis, a disease with a cure rate of under 50%. I remember that hospital as a place of despair. It was a giant open ward with a sea of patients shuffling around in pajamas, wearing masks. This was hell with a waiting list. But seeing hell didn't reduce my optimism; it channeled it. I got in the car and told the doctor who was working with us: "Yeah, I know. MDR-TB is hard to cure. But we should be able to do something for these people." This year, we're entering phase 3 with a new TB drug regimen. For patients who respond, instead of a 50% cure rate after 18 months for $2,000, we could get an 80–90% cure rate after 6 months for under $100. Optimism is often dismissed as false hope. But there is also false hopelessness. That's the attitude that says we can't defeat poverty and disease. We absolutely can. Melinda Gates: Ten years ago, I traveled to India with friends. On the last day there, I spent some time meeting with prostitutes. I expect- ed to talk to them about the risk of AIDS, but they wanted to talk about stigma. Most of these women had Bill Gates: The digital divide was a focus of mine in 1997 when I took my first trip to South Africa. I went there on business, so I spent most of my time in meetings in down- town Johannesburg. The next day I went to Soweto—the poor township southwest of Johannesburg that had been a center of the anti-apartheid movement. It was a short distance from the city into the township, but the entry was sudden, jarring, and harsh. I passed into a world com- pletely unlike the one I came from. I had seen statistics on poverty, but I had never really seen poverty. The people there lived in corrugated tin shacks with no electricity, no water, no toilets. Most people didn't wear shoes; they walked barefoot along the streets. Except there were no streets—just ruts in the mud. Before I went to Soweto, I thought I understood the world's problems, but I was blind to the most import- ant ones. I was so taken aback by what I saw that I had to ask myself, "Do I still believe that innovation can solve the world's toughest problems?" Over the years, Melinda and I did learn more about the most pressing needs of the poor. On a later trip to South Africa, I paid a The Gates' joint commencement speech Chief medical editor's corner of the world Bill and Melinda Gates deliver Stanford's first ever joint commencement speech in June 2014. Source: David F. Chang, MD L ast June, Stanford University's first ever joint commencement speech was delivered by Bill and Melinda Gates. Like other parents in the audience that day, I looked forward to their rare public speaking appearance and was curious about what their message would be to the graduating class. Their speech did not disappoint. The students and families seemed genuinely moved by the narrative—delivered in tandem—of their personal transformation into philanthropists. Hearing the world's wealthiest couple talk about how much of our success is derived from luck made quite an impression, and that they are giving away 95% of their wealth lent tremendous credibility to their message. The themes of optimism, empathy, and of innovating to solve the world's most important problems reminded me of how fortunate we in medicine are to have such opportunities through our careers in research or clinical care. While many commencement speakers have exhorted graduates to change the world, I doubt the arguments for philanthropy and volunteerism have ever been articulated so well. Because of space limitations, I've only highlighted excerpts of this inspiring speech for EyeWorld readers. You can watch the entire speech by searching "Gates-Stanford-Commencement" on You- Tube. You can also watch their recent TED interview by searching "TED-Gates-2014." Through the ASCRS Foundation and other international collaborations, I am continually impressed by how many ophthalmologists provide charitable care— whether in their practices, free clinics, or humanitarian outreach trips. It is a track record of which our profession can be proud. I invite interested ASCRS members to become involved with our Foundation's international programs or our Operation Sight domestic initiative to provide cataract surgery to those unable to afford care in America. The Gates' message to the stu- dents really applies to all of us in the medi- cal profession. Acknowledging our own luck helps us to be more empathetic and, when coupled with optimism, can move us to use our expertise to solve bigger problems. David F. Chang, MD, chief medical editor