I know it’s heartbreaking when you see children on the news with cancer or serious injuries that can’t be treated at home. I have a two-year-old and if, god forbid, he ever got seriously ill, I guarantee I would take him anywhere it took to save him. I have profound empathy with the families of sick kids. But sending one child to the US for care uses resources that could help an awful lot of kids in-country. It is the job of a parent to care for their own child first and foremost. It is the job of donors, governments, and NGOs to care for as many children as possible with the funding available. In my opinion, it is not an ethical use of limited resources to transport one child for health care.

When you bring a child to the US, you need to bring at least one relative as well, to look after the child in a strange place. If the relative is a parent, siblings at home will probably suffer emotionally and economically in their absence. If the relative is not a parent, they may have trouble making difficult decision about the child’s care. Assuming your medical care is donated, you still need to pay for their plane flights, housing, and food. For a long period, since they will need to stay in the US for all necessary follow-up appointments. The child and relative will need translators so they can talk to doctors. They’ll need a lot of help with informed consent to risky procedures. Often, at the end of it all, neither the child nor the relative want to go home. There is generally no way for them to stay.

Assume the medical treatment is successful, assume everyone goes home happy. What happens to the next kid with the same problem? If she’s lucky, the same effort that was generated for the last child. Expensive transport, a long time away from home and family, frightening and unfamiliar doctors who don’t speak her language. If she’s not so lucky, nothing. The next child with the same problem probably won’t get as much media attention because it’s not a novelty. There will be donor fatigue – finding donated care will be harder. Probably she is stuck in her home country with medical care she may or may not survive.

How do we do it better? It’s not very realistic to argue that you should just ignore seriously ill children and spend the money on public health interventions. No human can do that. On a practical basis, you probably have people willing to donate money for that one compelling child. You can’t just take that cash and save fifty children from malaria or helminths. But you can fly in a team of specialists or oncologists. You can most likely talk them into donating their time for the chance to help someone in a faraway location.

Team up your foreign doctors with local specialists. They can train the local physicians in how to treat the illness or perform the necessary surgery. They can train local doctors in how to provide the follow-up care. You may have to bring the sick child to the capital where facilities are available, but he is still in his own culture, speaking his own language. His relatives can alternate who stays with him so his siblings are not neglected. You’ll need translators for the foreign doctors, food and housing, but that’s still a lot less than sending people the other way. Yes, there are lots of complications; you may need to purchase, or find, donated equipment and drugs.

But now consider the next kid. She’s received a scary and terrible diagnosis, which requires sophisticated treatment. She travels no further than her own capital for care. She is treated by doctors who’ve been trained by American specialists, and her doctors can contact those American colleagues if they have questions. She can go home right after her treatment, and come back as needed for follow-up visits.