I am fascinated that some countries punch significantly above their weight when it comes to sports. Their performance in Olympics or world championships is disproportionate to what would be expected based on the size of the population. These countries have a high human capitalization rate for these specific events. Malcom Gladwell describes the human capitalization rate as “the percentage of people in any given situation who have the ability to make the most of their potential”. These countries set up an infrastructure that can identify the greatest proportion of individuals to excel in a field rather than occurs by chance.
Jamaica’s performance in track and field events in the Olympics is astounding. It has a population of 2.8 million, ranking 138 in the world in terms of population. Usain Bolt holds the men’s world record in the 100 meters and 200 meters. He is widely regarded as the best male sprinter of all time. Shelly-Ann Fraser-Pryce is equally prolific and revered as a female sprinter in the same events. Track and field is known as athletics in Jamaica and much of the world. It is among the most highly valued sports in their population. The high school athletics championships is one of the biggest athletic events in the country. Athletes are identified from a very young age and placed into a system that harnesses their talents.
Rugby is a national obsession in New Zealand. The All Blacks, New Zealand’s national men’s team, have won two out of the last three rugby word cups and the women’s national team, the Lady All Blacks, are the current world champions. This for a population of ~ 5 million. Anyone who has seen a pre-rugby Haka https://www.youtube.com/watch?v=yiKFYTFJ_kw can attest to how this sport unites the country and combines cultural elements of its native Maori population with a sport introduced by English colonists. Rugby has a high participation rate among youth which carries on through adulthood; the number of registered rugby players in New Zealand is higher than in both Australia and England. The national teams draw from a larger talent pool than most countries. Once this talent is identified, it is cultivated in a system of year-round training and top-level coaching. This results in New Zealand being consistently one of the best rugby sides in the world.
Ideally, society would capitalize on everyone’s talent. This would ensure that an individual would pursue an activity that they both enjoy and are suited to excel. Currently, this is not possible. There are a myriad of activities and individuals can excel at more than one. Often, the infrastructure to capitalize on a talent are dictated by the preferences of the setting and those who are committed to building the infrastructure.
I think there is an analogy that can be drawn for neurology in Zambia. We are not capitalizing on all the talent but we are performing better than average for the region. There are countries with a similar population and talent in surrounding countries who are not producing the same number of neurologists, having the same neurological outcomes, or similar academic output in terms of research and publications. The main reason is that there is not an environment in those countries to support those who would otherwise be successful. Someone may trickle through based on their own unrelenting effort. An example of this would be Melody Asukile from Zambia who sourced her own funds and got into a training program at the University of Cape Town because we did not yet have a program locally.
Now that the local program is flourishing under the leadership of Dr. Deanna Saylor, there are Zambian neurologists who graduate every year, building on the existing infrastructure to further help capitalize on the talent within Zambia. There are now plans to train neurologists from other African countries to help seed a neurological infrastructure in those countries.
There was nothing particularly special about neurology over other specialty areas in Zambia that continue to have training gaps such as rheumatology and dermatology. It was simply a matter of a group of individuals recognizing a need and developing the infrastructure to address this need. Capitalization of talent occurs more quickly when the environment already exists. The late Paul Farmer labeled areas that did not have adequate healthcare infrastructure as medical deserts but noted that “one of the most exciting things about global health is that if you irrigate a medical desert, it always blooms”.
