Good point, thanks, I was thinking I should have addressed that. The thing was that no one was digging ditches. Yes, given a choice, it would be more efficient

Good point, thanks, I was thinking I should have addressed that. The thing was that no one was digging ditches. Yes, given a choice, it would be more efficient to use unskilled labour than a surgeon... but it would be better to have a surgeon doing it than having no one doing it. In practice, I imagine his role as an advocate and organizer: a kind of charity-entrepreneur, and maybe leading by example, gandhi-style, rather than being an ordinary ditch digger. "This is so important, that I can save more lives by doing it instead of doing surgery". Of course, there are many problems with making infrastructure changes, cultural, practical, political; and maybe it needs special talents, skills, values and especially personality that even a highly intelligent, competent and committed surgeon may lack. But if you believe that's the best way to improve health, and you are committed to improving health, then...