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Members of the American Surgical Assoication, honored guests, ladies and gentlemen: First, allow me to thank the membership for electing me president of this august organization. The greatest honor that can be bestowed on any surgeon is to be elected president of this, the oldest and most prestigious surgical association in the nation. For me, personally, it is not only the greatest honor of my life, but also the most unexpected.And now, let me take a moment to thank the most important person in my life, my bride of 33 years, Kim. I could not have accomplished what I have were it not for her love, her endless patience, her unfailing support, and her great personal sacrifice. Kimmie, thank you.At last year’s meeting in Colorado Springs, when my election as president was announced, my dear friend Dr. James C. Thompson of Galveston approached me with his characteristic broad smile and boyish demeanor and whispered in my ear, “There goes the neighborhood!” He was the first to acknowledge that my election as ASA President was unusual: I am the first minority to hold this office and a relatively recent immigrant from a small African village, Saganeiti, in a small African country, Eritrea, one of the youngest and poorest countries in the besieged Horn of Africa.Given these unlikely circumstances, I debated how to entitle my address. Should it be: “It can only happen in America,” or “From Saganeiti to San Francisco”? In the end, I chose neither. Instead, I have selected the title “Surgery: A Noble Profession in a Changing World.” While carrying a faint echo of the sentiments I just expressed, the title allows me to expand on the views and concepts I have acquired as a surgical department chair, dean of a school of medicine, and chancellor of a health sciences university at the end of the 20th century and the beginning of the 21st.Surgery is, indeed, one of the noblest of professions. Here is how Webster’s Third New International Dictionary defines the word noble: 1) possessing outstanding qualities such as eminence, dignity; 2) having power of transmitting by inheritance; 3) indicating superiority or commanding excellence of mind, character, or high ideals or morals.These three attributes befit the profession of surgery. Over centuries, the surgical profession has set the standards of ethical and humane practice. Surgeons have made magnificent contributions in education, clinical care, and science. Their landmark accomplishments in surgical science and innovations in operative technique have revolutionized surgical care, saved countless lives, and significantly improved longevity and the quality of human life. Generations of surgeons have developed their craft and passed it on to succeeding generations, as they have to me and to each one of you, to take into the future.Beyond its scientific and technical contributions, surgery is uniquely fulfilling as a profession. It has disciplined itself over the centuries and dedicated its practice to the best welfare of all human beings. In return, it has been accorded the respect of society, of other professions, and of policy makers. Its conservative stance has served it well and has been the reason for its constancy and consistency.At the beginning of the 21st century, however, profound changes are taking place at all levels and at a dizzying pace, providing both challenges and opportunities to the surgical profession. These changes are occurring on a global level, on the national level, in science and technology, in healthcare, and in surgical education and practice.