To do that, he would need to inflict a bit of pain.
He would need to do some quick tests to calculate the farmer’s Glasgow Coma Scale, a rough way of measuring the severity of a brain injury. Dilan leaned toward the man, who appeared to be unconscious. Mayegga had heard that he’d fallen while in a stupor and bashed his head. The circumstances of his injury were vague. Dilan squeezed past other patients to reach the man, who lay motionless under a maroon blanket. The salty and slightly metallic smell of blood mixed with the scents of soiled sheets. Like the other rooms, it had about twenty beds and at least as many patients. They found the farmer in a room with a window view of the hospital’s dirt driveway. Inside, patients spilled out of rooms lining both sides of a dark hallway. The surgical ward was on their left, and they entered through a heavy wooden door. To their right, patients waited next to a window to pay their bills. Dilan, please, is there something you can do for this man?”ĭilan followed Mayegga through Radiology outside to a breezeway between the hospital’s buildings. Mayegga wasn’t sure if the injury was a subdural or epidural. He’d been on call during the night when a patient with a head injury arrived. Mayegga had a round face, almond skin, a wisp of a mustache, and a high hairline that made his forehead stand out. The morning radiology meeting broke with the sounds of moving chairs. He didn’t know it at the time, but twelve countries in sub-Saharan Africa had no neurosurgeons at all. The United States had 3,700 neurosurgeons - not enough to keep up with the demand in either country. And all three were in Dar es Salaam, the country’s biggest city, five hundred miles away. Three for an entire country of forty million people. Prior to his arrival, Tanzania had just three practicing neurosurgeons. As far as he knew, he was the first brain surgeon to visit Haydom for any length of time, perhaps ever. Word had gotten around quickly that he was a neurosurgeon. He would let his mind wander.Īs he neared the wards, people nodded and smiled. Just a few easy cases in the morning to keep his surgical skills sharp, and then maybe a nap or a book or a run, whatever. Dilan Ellegala would be limited to the most basic forms of neurosurgery, which was fine with him. Instruments were scattered across a storeroom that looked like a teenager’s closet. Patients under anesthesia were ventilated by squeezing an oxygen bag with your hands. The theaters had no operating microscope. Reprinted with Permission from Beacon Press.īrain surgery, or at least anything more complex than drilling burr holes, was out of the question at Haydom Lutheran Hospital in Tanzania. Adapted from " A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa" by Tony Bartelme ( Beacon Press, 2017).
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