Nazila Fathi was a correspondent for the New York Times based in Tehran from 1999 to 2009 and is the author of “The Lonely War: One Woman’s Account of the Struggle for Modern Iran.”
In 2006, when American doctor Dilan Ellegala arrived in Haydom, on the edge of Tanzania’s Great Rift Valley, he uncovered a shocking reality: This country of more than 40 million people had only three neurosurgeons. All of them were in the capital, Dar es Salaam.
Ellegala, who had recently graduated from Harvard Medical School, was the first brain surgeon at Haydom Lutheran Hospital, a medical center that depended on volunteer doctors from Europe and the United States. The facility lacked the most basic surgical tools. Patients with head injuries or brain tumors healed on their own or died. The operating theater did not have a functional microscope; the light was too dim; patients under anesthesia were ventilated by an assistant squeezing an oxygen bag by hand. Every bed in the hospital was occupied. Some patients slept two to a bed; some slept on floors or benches outside the rooms.
In “A Surgeon in the Village,” journalist Tony Bartelme recounts Ellegala’s efforts to improve the medical system in Tanzania. Bartelme followed Ellegala for four years, staying at the hospital where he worked, witnessing the dire conditions that made his mission so difficult. The result is a harrowing and important book that captures the tremendous health-care challenges facing East Africa and opens our eyes to a complicated global health problem: lack of access to safe, affordable surgery and anesthesia. Bartelme says an estimated 17 million people die every year from conditions that could have been treated surgically.
Early on, Ellegala was forced to make some difficult decisions. One day, for example, an unconscious man was brought to the hospital; cerebrospinal fluid was leaking from his ear. Ellegala needed a Gigli saw, a $20 instrument used for cutting bones, to open the man’s skull and save his life. The only one at the hospital was rusty and broken. Defeated, Ellegala decided to go out for a run to clear his mind. On his way, he came across a farmer who was cutting a tree limb with a wire saw. Ellegala bought the tool and rushed back to the hospital, where he sterilized it and used it to perform the surgery.
Ellegala saved the man’s life, but a question haunted him: What happens after visiting doctors leave Haydom?
Ellegala couldn’t cure every Tanzanian with his own two hands, so he tried the next best thing: training other surgeons. His first student was a Tanzanian medical assistant, Emmanuel Mayegga, whose education was comparable to that of a high school graduate in America. Over a few weeks, Ellegala taught Mayegga some brain surgery techniques and built his confidence to perform surgeries. It was a risky move, Bartelme admits, but, given “that millions of people had no access to even the most basic forms of neurosurgery,” the options were limited. “Was it ethical,” he asks, “to wait until a country built a stable of experienced surgeons, a process that might take decades, if it would happen at all?”
After Ellegala left Tanzania a few months later, Mayegga began operating on patients with head wounds. He helped another health-care worker, Emanuel Nuwas, to master the techniques and perform neurosurgery. Nuwas would also, as part of Ellegala’s “train-forward” philosophy, teach others.
Ellegala, who also practiced in Portland, Ore., and later in Charleston, S.C., founded a nongovernmental organization called Madaktari Africa. It sends hundreds of doctors around the world to serve as mentors and to create a sustainable model for global health. To address concerns about instructing clinicians to perform complicated brain procedures, Ellegala encouraged Mayegga and Nuwas to attend medical school in Dar es Salaam. Both men returned to Haydom after completing their studies to advocate Ellegala’s teach-first philosophy — a testimony that empowering people turns them into agents of change.
“Teaching has the power to change people’s internal wiring, help them do things they never thought possible. And teaching is a universal value, as basic as a father teaching a son to tie his shoes, which means it can be a unifying force,” Bartelme writes.
Bartelme argues that Ellegala’s effort to build a functional health system, even though it means relying on locals who lack credentials required in the West, is more important than the humanitarian aid that has poured into Africa for decades. Such programs are well intentioned but keep low-income countries dependent.
The Ebola crisis in West Africa in 2014 underlined the importance of a health-care system that can stand on its feet. Nearly 95 percent of foreign health-care workers packed their bags after the Ebola outbreak, and the locals were left on their own to fight the deadly virus. “Hospitals and clinics closed; the disease spread to Nigeria, Mali, Senegal, and then the United States and Spain. West Africa’s problem became the world’s problem,” Bartelme writes.
It wasn’t until thousands had died that governments and humanitarian aid groups stood together to stop the disease. If African doctors had been empowered to fight it in the first place, Bartelme argues, the scale of the crisis would have been different.
“In a world of trauma and disease,” he concludes, “destinies are often shaped by access to healers. And without this access, ripples of suffering can become waves.” Training healers can stop that wave.
By Tony Bartelme
Beacon. 274 pp. $27.95