The Current

How brain surgery with a tree saw led to a rethink of medical aid

Neurosurgeon Dr. Dilan Ellegala set about creating a new model to solve the chronic shortage of doctors and surgeons in rural Africa by putting the surgeon's skills in their hands.
Dilan Ellegala trained health care providers to do basic surgical and neurosurgical procedures, rather than having foreign doctors on "medical missions" treat most of the patients. Emanuel Nuwas (L) is the second Tanzanian health care worker trained by Ellegala (R). (Tony Bartelme/Harper Collins)

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Haydom Hospital in rural Tanzania is the closest hospital for 600,000 people and the facility to which approximately 2.5 million patients are referred. In the area, many children are born with cerebral water that doesn't drain, and they eventually die from cranial pressure.

While the cerebral water can be drained by drilling a hole into the skull, local doctors by and large aren't qualified to carry out such procedures. Many of the doctors at Haydom Hospital come from abroad, taking their skills with them when they leave.

Enter Dr. Dilan Ellegala, an American neurosurgeon who set about creating a new model to solve the chronic shortage of doctors and surgeons in rural Africa by imparting his surgical skills and knowledge. He's the founder of Madaktari Africa, a health NGO that promotes a "teach first" model of medical aid.

"When I first went 10 years ago in 2006, there were two Tanzanian neurosurgeons in the entire country of 40 million people. And if you look at the U.S., or Canada, or Europe, there's a neurosurgeon for every 100,000 patients," Ellegala says.

The doctor shortage was not the only problem. When Ellegala was treating his first brain injury patient, he realized he would have to get creative to find tools — the hospital had no electric drill, no ventilators and no cautery devices. Ellegala went for a walk one afternoon and saw a man cutting a tree with a wire saw. Ellegala bought the man's saw, sterilized it and used it for the procedure. 

After the successful neurosurgery, Ellegala set out to train Tanzanian health care workers, so that even after he left, Haydom Hospital would have the resources to look after their patients. Ellegala started with Emmanuel Mayegga, who was working as an assistant medical officer, though he didn't have a medical degree, but Ellegala could see potential.

"You can tell a surgeon by the way they walk, by the way they talk, by the way they move — and he had confidence, he clearly was hungry and he was capable," says Ellegala.

After successfully training Mayegga — who has since received a medical degree — Ellegala and Mayegga jointly trained two more health care workers, Emanuel Nuwas and Hayte Samo, and the three cover most of the neurosurgery at Haydom Hospital.

Tony Bartelme, who wrote about Ellegala's mission for "teach first" medical aid in Send Forth The Healing Sun: The Unexpected True Story About Teaching Brain Surgery in the African Bush, says the shortage of local doctors is a major issue not just in Tanzania, but worldwide. He says a contributing factor to this insufficiency is, in fact, the doctors who come from other countries, since it hinders the development of local practitioners. 

If you have lots of foreign doctors coming in, taking care of the medical needs of a particular country, there's a lack of incentive for a country to build their own health care.- Tony Bartelme, author of Send Forth The Healing Sun: The Unexpected True Story About Teaching Brain Surgery in the African Bush- Tony Bartelme, author of 

Ellegala believes the medical community stands to gain from their experience at Haydom Hospital.

"By teaching people to be independent we're changing the way they think about what's possible, and it's opening up a world of possibilities that never existed before."

Listen to the full conversation at the top of this post.

This segment was produced by The Current's Karin Marley.