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The story behind A Surgeon in the Village (USA) and Send Forth the Healing Sun (Canada)

Photo by Annie Duryee

The Tip


“Tony, I’ve got a great story you should check out.”


As an investigative reporter for Charleston’s Post & Courier, I know good tips are passports. Not so much to fascinating new places, although that would certainly happen in this book's case. But mostly they take you to moments of uncertainty -- and how someone handled that defining moment. Good tips also can expose corruption and give voices to those who have none. But over the years, I’ve also gotten my share of duds. So, when I heard about a neurosurgeon doing “some crazy brain surgery in Tanzania,” I was skeptical but intrigued.


Brain surgery in the bush?


I arranged to have lunch at a restaurant in the antebellum house across from the Medical University of South Carolina. He was late, and as the minutes passed, I stared at the house’s woodwork and pondered the audacity it takes to open someone’s skull. I thought about the term “god complex” and about priests and politicians and other people who hold tremendous power. More minutes passed. The restaurant became a waiting room.


Then Dilan walked through the doors, still in his pale blue scrubs. He folded his long frame into a wooden chair. Dilan was younger than I expected, about forty. He had a shaved head, a useful teaching aid for a neurosurgeon. He had a prominent nose and large eyes framed by arching black eyebrows.


“So, brain surgery,” I said, “piece of cake, right?” I searched Dilan’s face for a reaction.


“Yeah, it’s not so tough,” he replied with a smile.


As it turns out, Dilan shares my impatience with authority figures. It was a good introduction for both of us. I moved the conversation to Africa, and his eyes brightened. “It’s just awesome,” he said, and told me how he ended up in Tanzania, how he’d gone there to save himself, not the world, and how in the process, he’d found a new mission.


Life and Death


“Here’s the real story,” he continued. Charleston, a metropolitan area of about 700,000, has more than 20 neurosurgeons. At the time of his first visit, Tanzania had only three for an entire country of forty-three million people.


“Three?” I said. “What happens to patients who need brain surgery?”


“Exactly,” he answered, pointing his finger for emphasis. Because of this chronic shortage, care had long been left in the hands of foreign doctors and overseas volunteers. These doctors typically were members of medical missions that treat as many patients as possible, but only for a few weeks at a time. This created a cycle of dependency that ultimately had done more harm than good. It perpetuated a shortage that required new infusions of foreign doctors to prevent the system from collapsing; it infected the psychology of the Tanzanians, who in meetings stood quietly in the back of the room while foreign doctors and medical students dominated the discussions.


Near the end of our lunch, Dilan said that he taught a Tanzanian medical officer how to do basic brain surgery. In Tanzania, a clinical officer has the education equivalent of a high school diploma and a few years of formal medical training. Dilan felt his work with that clinician was a vivid example of how teaching should be the primary goal of a medical missions, and foreign aid in general.


The biggest global health problem you've never heard of


I left energized by Dilan’s charisma and optimism. He was at once likable and intense. I loved that he said “awesome” over and over, not like a surfer dude, but like someone trying to capture a whole landscape of experiences, people, and goals. Instantly, I felt he was one of those special people you meet who makes you think about larger things in life, a visionary. I remembered that Chinese proverb: “Give a man a fish, feed him for a day; teach a man to fish, feed him for a lifetime.” But instead of fishing, it was brain surgery.


So I knew on an intuitive level that I had a story here, something important. I described these intuitions to my newspaper’s executive editor, and amid a round of layoffs in 2010, he transferred money in his travel account to send me to Tanzania with Dilan. And it was in Haydom, a small town in the bush, where I began to see the story’s grander sweep, where I met Emmanuel Mayegga, Emanuel Nuwas, Hayte Samo and the other characters in Send Forth the Healing Sun.


When I published a four-part series for The Post and Courier called “One Brain at a Time,” the stories generated significant interest within and outside South Carolina; the Association of Health Care Journalists recognized the series as one of the nation’s best medical stories of the year. The series was a finalist for the 2011 Pulitzer Prize.


While working on “One Brain at a Time,” I was awarded a year-long Nieman Fellowship at Harvard University. I changed the entire focus of this fellowship to do more research on the historical and global implications of what I had seen in Haydom.


In the process, I discovered that I had only touched on what is among the most underreported issues in global health: From sub-Saharan Africa to South America, vast numbers of people die or live with debilitating injuries because of a severe shortage of surgeons and other medical specialists. It’s a growing problem that affects 5 billion people on the planet. It plays out in Vietnam, where mothers carry their children on their backs for days to reach medical missions, only to be turned away because the volunteer doctors are gone. It can be seen in Peru, where mothers die in childbirth because no doctor is available to perform a routine C-section.


A better path


I spent the next three years working on Send Forth the Healing Sun. I traveled to Tanzania five times. I met the president. I watched one operation after another. I had the privilege of getting to know many wonderful people, Tanzanian, European and American.


Send Forth the Healing Sun is a unique story because it merges global health, medical ethics, and personal moments of decision. It does what New York Times film reviewer A.O. Scott says great novels do: Blend private destinies with public events. And it’s a compelling true story, one that describes a path toward improving the lives of millions of people, a path illuminated by the word doctor itself:


In Latin, the word for doctor isn’t healer. It’s teacher.



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