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PART III: Teach One


Chapter 41


I first  learned  about  President  Jakaya  Kikwete’s  woman-in-basket story from the website Campaign on Accelerated reduction of Maternal Mortality in Africa (CARMMA). I later confirmed and added details through personal interviews with the president and Mohamed Janabi.


Details about Julius Nyerere were collected from a number of sources, including David Lamb’s The Africans, random House (1983). Information about the number of political prisoners came from Lamb’s book. Details about Nyerere’s visit to Haydom are in The Haydom Adventure by Bjorn Enes and the memories of Mama Kari Olsen and Naftali Naman.


Information about the number of doctors in Tanzania is from John Iliffe’s East African Doctors, Cambridge University Press (1998). Information about stunting and nutrition in Tanzania is from USAID. Information about Kikwete’s visit in 2008 was compiled from interviews with the president and the two hospital staffers who escorted him: Emmanuel Mighay and Isaack Malleyeck.


Chapter 42


Emanuel Nuwas and I visited Charles Petro’s hut to see how he was doing. Nuwas translated his story into English as we spoke.


Chapter 43


Hayte (Hi-yeh-te) Samo told me the bulk of his story in Dar es Salaam when he was doing his advanced surgical training. Among Hayte’s other accomplishments: He worked with a filmmaker to do the first ever Datoga- language film, Ukimwi Datoga! (Datoga let’s beware of AIDS!). Hayte played the lead role of a herder who goes to town, gets drunk, has sex with a prostitute, and brings AIDs back to his community. With Herman Malleyeck, I also traveled to Hayte’s home place, where among other things mentioned, I saw the two trees where he went to school.


Chapter 44


Data on stroke deaths come from the World Health Organization. Data on stroke prevalence in South Carolina are from the South Carolina Department of Health and Environmental Control. Leonard rodwell told me the story of his wife’s aneurysm.


Information about the prevalence of lawsuits filed against neurosurgeons can be found in “Malpractice risk According to Physician Specialty,” Anupam B. Jena, Seth Seabury, Darius Lakdawalla, and Amitabh Chandra, New England Journal of Medicine, vol. 365 (Aug. 18, 2011).


Chapter 45


Jane Word’s artwork was featured in “House on Folly Captures Spirit of the Area in a Big Way,” by Wevonneda Minis, (Charleston) Post and Courier (Sept. 7, 2013).


Chapter 46


The National Museum of Quackery closed in 1984. Other notable neurosurgeons who attended the meeting included roger Hartl, a neurosurgeon for the New York Giants who gained national attention for reassembling the spine of a firefighter in the Bronx who fell five stories out of a burning building. Hartl had done medical missions in Tanzania. Mike Haglund of Duke University had done impressive work in Uganda. Kevin Lillehei of the University of Colorado made a detour to St. Louis on his way back from a teaching trip to Haydom.


Chapter 47


Sunil Patel is a compact man with glasses and an accent that’s a blend of his Indian roots and three decades in South Carolina, part curry, part shrimp and grits. He was born in Dar es Salaam, which has a large population of Indian immigrants, and moved to Zambia when he was five. In Dar es Salaam, he told me about a monkey in his backyard in Zambia that he named Chiku. They played jokes on each other and taunted each other until one day his family said they were moving to the United States. Chiku bolted, never to be seen again. Patel eventually majored in physics at Clemson University and then went to MUSC for his MD.


Chapter 48


The look on Dilan’s face when he got the call from President Kikwete was a mix of amusement and confusion. “It took me a minute to figure out that it was really him.”

The scene in the president’s private residence is based on recollections of Dilan and D Word, as well as photographs taken by the president’s photographer.


Chapter 49


As described in Incognito, the neuroscientist David Eagleman studied perceptions of time by having people go on a theme park ride that drops people from a great height. He then asked them to estimate the length of time they took to fall. People routinely said the drop was longer than it actually took.


Robert Lutton’s Toxic Charity was published by HarperCollins (2011). Lupton’s reference to “beggars” can be found in The Mennonite (June 16, 2009).


The study analyzing short-term medical missions and other models appeared in the World Journal of Surgery, “Charitable Platforms in Global Surgery: A Systematic review of Their Effectiveness, Cost-Effectiveness, Sustainability, and role Training,” Mark G. Shrime, Ambereen Leemi, and Thulasiraj D. Ravilla, vol. 39 (2015).


For more information about the Rwanda model, see “The Human resources for Health Program in Rwanda—A New Partnership,” New England Journal of Medicine, Agnes Binagwaho et al., vol. 369 (Nov. 21, 2013).


For information about the number of people who die every year from surgically treatable diseases, see “Global Burden of Surgical Disease: An Estimation from the Provider Perspective,” Mark G. Shrime, Stephen W. Bickler, Blake C. Alkire, and Charlie Mock, The Lancet, vol. 3 (April 27, 2015).


A landmark study on the shortage of surgeons appeared in “Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development,” by Mark Shrime et al., The Lancet, vol. 386 (Aug. 8, 2015).

In May 2015, the World Health Assembly passed an international resolution to strengthen surgical care across the globe.


Maarten Hoek, Carin’s brother, and James Kenning, also were present the night Dilan and D Word met Nuwas in Arusha.


Chapter: 50


Life Without Care: Losing Haydom Hospital was produced by Michal Venera. His work can be found at:


Chapter 51


The Nyaturu boy, Paolo, was discharged a few days after Mayegga performed surgery.


Chapter 52


In addition to Nuwas and Hayte, other Tanzanian specialists arriving in Haydom included two obstetricians, Yuda Munyaw and Paschal Mdoe, another surgeon, Daudi Lotto, and for the first time in the Lena Ward, a Tanzanian pediatrician, Judah Gideon.


Chapter 53


For more information about deforestation’s link to Ebola, see “How Palm Oil, Fruit Bats and Deforestation Could Be Linked to Ebola Epidemic,” by Kevin Grandia, Ecowatch (Jan. 20, 2015).


For statistics about Liberia’s health care worker shortage, see “Implementing Liberia’s Poverty reduction Strategy,” by Lawrence Sherman et al., Archives of Surgery, vol. 146 (2011). For more on the decisions humanitarian workers faced, see “With Aid Doctors Gone, Ebola Fight Grows Harder,” by Sheri Fink, New York Times (Aug. 16, 2014).


“Essential Surgery” is the first volume of Disease Control Priorities, Third Edition (DCP3), published by the World Bank Group (March 2015). It identifies forty-four essential surgical procedures that should be available in low- and middle-income countries.


Information about the future economic consequences of the surgeon gap is in The Lancet paper “Global Burden of Surgical Disease: An Estimation from the Provider Perspective.”


For a discussion about how to speed up the training of doctors, see “Should It really Take 14 Years to Become a Doctor?” by Brian Palmer, Slate (March 13, 2014). In May 2015, doctors from Zambia, Malawi, and Europe began work on two pilot studies to see if clinical officers could   be trained to do basic surgeries. The program is called Clinical Officer Surgical Training-Africa (COST-Africa).




For information about the study comparing more intensive bedside teaching with the rotation of visiting doctors, see “Neurosurgical Capacity Building in the Developing World through Focused Training,” Journal of Neurosurgery (2014). Its authors include Dilantha Ellegala, Lauren Simpson, Emmanuel Mayegga, Emanuel Nuwas, Hayte Samo, Naftali Naman, D Word, and Joyce Nicholas.


Shannon Frazier did well after her surgery. Eighteen months later, she told me: “I felt as if I was given a second chance at life.”




Mayetta and a friend, Daniel Anania, at the International Medical and Technological Institute in Dar es Salaam. Photo/Bartelme

Hayte went to classes under this tree. Photo/Bartelme

I found Hayte's old teacher not far from the trees where Hayte went to school.

Dilan greets Hayte Samo in 2010 just after Sala. Photo/Bartelme

D Word talks with President Jakaya Kikwete.

The bung'eda burial tomb for Hayte Samo's father. Photo/Bartelme

Mayegga and Nuwas head to the surgical theaters in October 2013, after Mayegga mentions that he smashed his thumb.

Mayegga and Jonas Scheck, a German med student, do rounds in October 2013. Photo/Bartelme

Dilan Ellegala and team at Centra Health in Lynchburg, Virginia, do the state's first standstill operation. Photo/Bartelme.

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