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Unfortunately it is hard for a minority of well-intentioned smart people to make a dent in an overall mediocrity. The Soviet Union had a huge number of extremely smart people including absolute geniuses of math and science and engineering, yet it was a backwards authoritarian shithole. Even modern Russia (despite a lot of brain drain these past 30 years) still has a lot of smart people, yet it is a shithole.
For the individual, the strategy of moving to a place that is already not a shithole usually makes a lot more sense than staying in a shithole and trying to improve it.
I've already given an entire year of my life, of my own volition, to working as an intern in a far larger and more active government hospital in lieu of my original, rural one.
It was just about the worst year of my life, I was working insane hours and not even getting paid for it (unlike those who stuck to wherever their med school was).
The worst of it was that I realized that if I went through the insane grind needed to get into a decent postgraduate specialization program, I could look forward to a similar lifestyle for another 3 or 4 years. If I hadn't already harbored aspirations of jumping ship, that alone would have made me.
If you want to read it, it's here. Probably one of the best things I've written.
If anybody tries to force me to go through that again, I'd punch them.
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