In lieu of an abstract, here is a brief excerpt of the content:Building a FoundationRichard KeidanA guiding principle of Judaism is "tzedakah," which translates as charity but actually means righteousness, reflecting that tzedakah is an obligation, not a choice. This concept of social justice was taught to me at home, at school and at synagogue. I gave to charities and did occasional charitable work. As my parents had taught me, I taught my own children the spirit of giving, but it (...) did come from a place of obligation, not passion. I have since come to learn that there is a world of difference between just fulfilling our obligations to each other and letting them guide the kind of person we become.It is ironic how the process of becoming a doctor—a person society expects to be selfless— requires total self-absorption. Think about it. I was trained to compete with my classmates in order to be accepted to the best university, medical school, residency, and then fellowship. I spent more than one hundred hours each week in the hospital during surgical residency. If I had free time, I wanted to do what I wanted to do. I was so focused on the end result that I had little time to think of others, let alone to ponder the inequities of the world.Several events led to the awakening of my conscience. One was an opportunity to go to Ethiopia and perform a couple weeks' worth of cancer surgery through Mother Teresa's Clinic. Quite frankly, I went because it seemed like an exciting adventure. However, I was completely overwhelmed by the experience. The conditions were abominable. The stories of each of my patients were heart-wrenching. I encountered a 14-year-old boy, the same age as my son, who had a tumor 15 cm in thickness wrapped around his neck. In order to hide the tumor he wore a scarf, but this still did not prevent him from being shunned. He traveled by himself for several days on a bus to reach the clinic. He had no one to advocate on his behalf, was unable to speak the local language, had never been outside his village (let alone in a motor vehicle), and he fearlessly underwent major surgery all by himself.The inequalities in health care compared to my suburban hospital were unfathomable. I cried every night in my hotel room. There seemed to be no solution to this situation. Soon after I returned home, Ethiopia became a distant memory. The experience cut me to the bone, but for whatever reason, I did not rally. I did not see myself as part of the solution. It took an entirely different international experience to open my eyes.There is a saying, "One goes to the Himalayas to see the mountains, but returns for the culture." In 1982, on a sabbatical from my surgical training, I went to Nepal to see the Himalayas, but fell in love with the people. Living in the most basic shelters, eating the most basic diets, with no access to clean water or toilets and little access to health care or education, the people seemed happy. I was invited into their homes and lives, slept on their straw mats, ate their rice and drank their tea. Their spirit and sense of contentment drew me back over the years 15 times. Nepal became a sanctuary for me, a place that gave me time to reflect upon what is truly important, a place that provided energy and inspiration for me. Its public health and education needs were apparent to me, but again, I felt sympathy for my Nepali friends; I did not see that I could—and must—help.It took a chance meeting to change that. Two years ago, I was on an exploratory trek on the Great Himalayan Trail in the Kanchenjunga region of Nepal. Namgyal was our sirdar (head sherpa guide), short in stature, but a giant of a man. Lacking a formal education, but very bright and [End Page 84] motivated, he rose through the ranks from porter all the way to lead sherpa of Everest Expeditions. He had reached the summit of Everest ten times by the age of thirty. He led... (shrink)