Here, Dilan Ellegala, a U.S. neurosurgeon, prepares to teach a German and Tanzanian doctor how to relieve the pressure in the baby's skull.
Buy this photo
, TANZANIA - A baby lies swaddled in green towels in a hospital on the edge of Tanzania's
Rift Valley, her
head bulging from hydrocephalus, her
brain slowly self-destructing.
Dilan Ellegala, an American neurosurgeon, stands nearby as two young doctors prepare to open the baby's skull.
In 2006, Ellegala
spent six months here on a working vacation.
And buoyed by their success, Ellegala
, formerly of Charleston, created a nonprofit called Madaktari Africa
, with the goal of curing a problem that some call the "neglected stepchild of global health.
From sub-Saharan Africa to South America, vast numbers of people die or live with debilitating injuries and diseases because of a severe shortage of surgeons and other medical specialists.
Over the next few years, Madaktari
(Swahili for "doctors") Africa evolved into a multi-faceted experiment in how to help others in poor countries.
Instead of setting up short-term medical missions - trips where doctors swoop in and treat as many patients as possible, then leave - Madaktari
would focus on training people, then teaching them to train others.
hoped this "teach-first" approach would lead to a new generation of medical leaders in Tanzania and reduce its dependence on foreign doctors.
Working with doctors, students and nurses from the Medical University of South Carolina
, Madaktari Africa set up cardiology, anesthesia and dialysis training programs.
More than 500 volunteers from seven other U.S. and European universities traveled to Tanzania to teach.
The president of Tanzania
had become one of Madaktari's strongest supporters.
And yet, in late January, Ellegala
is back in the operating room in Haydom
with a baby suffering from hydrocephalus and no Tanzanian around with the skills to save her
hands in an old sink outside the operating room as a nurse inside leans next to a tray of silver instruments, a clutter of scissors, retractors and forceps.
Doors to the hall swing open and closed, vectors for infections and flies.
Ellegala is a tall man with a shaved head and dark arching eyebrows.
He was born in Sri Lanka but moved to South Dakota with his family when he was 5.
Even at that young age, he
wanted to be a doctor.
In medical school he decided to specialize in neurosurgery because he loved the complexity of the brain and the challenge of fixing it when something went wrong.
Like most American neurosurgeons, he
spent much of his
young adulthood training toward this goal.
In all it took 14 years of medical school, residency and fellowships, and when he
emerged from this tunnel of education, he
To clear his
decided to spend six months at Haydom Lutheran Hospital
, partly to keep his
skills sharp but mainly just to explore and unwind.
plans changed as soon as he
But amid this excitement, Ellegala
wondered: What happens when I leave?
began to see that foreign doctors like himself were making the problem worse.
After seeing him work with patients, Ellegala
told him one day, "You can be a neurosurgeon."
reassured him; he
would teach him what he
needed to know and would be nearby in case he
ran into trouble.
For the next six months, he
showed Mayegga how to treat people with head injuries, insert shunts into babies with hydrocephalus and do other basic brain surgeries.
was a natural," Ellegala
"Within a few weeks, he
was doing procedures on his
Over the next few years, Ellegala and Sunil Patel, chairman of MUSC's neurosurgery department, traveled to Haydom and taught Nuwas ever-more complex procedures, including tumor removals that would challenge the most experienced Western neurosurgeons.
Better yet, when Ellegala
and other researchers studied mortality rates of patients and other quality factors, they found their work comparable to formally trained neurosurgeons at other African hospitals.
knew that teaching brain surgery outside medical school channels was an educational short-cut, but the alternative was worse - certain death for many patients who would never have access to neurosurgical care.
Encouraged by these results, Ellegala founded Madaktari Africa to promote this teach-first philosophy across East Africa.
It was a direct challenge to traditional medical missions, which have only grown in popularity in recent years as universities vie to offer students global experiences and religious groups look for new ways to evangelize.
Today an estimated 500 groups around the world run upward of 6,000 short-term medical missions a year.
"I think it's in the nature of doctors to go in and give the patient the best care possible no matter what," Ellegala
"But this also sends a message to local doctors and nurses that they can't take care of their own, and that's shameful."
Lunch with president
But running a nonprofit proved a challenge.
Ellegala had full-time duties as a neurosurgeon, first at MUSC and then, 18 months ago, when he left Charleston to become medical director of the Centra Neuroscience Institute in Lynchburg, Va.
had a young family.
Together, Word and Ellegala
put their teach-first philosophy into practice.
"The traditional thinking is that can't be done by an assistant medical officer, that it's supposed to be done by an MD, but Dilan
colleagues proved that it can be done by anybody.
It is a big inspiration, definitely.
Nothing is impossible."
often used similar words about the uplifting power of education.
But amid this support and presidential pomp, he
had wondered whether teaching-focused programs were enough.
"If you go online, you'll see a hundred or a thousand other NGOs also say 'sustainable' or 'teach a man to fish,'" he
said to Word one late afternoon.
These terms have become fundraising mantras.
Was Madaktari's approach truly sustainable?
Ellegala had encouraged Mayegga to get his MD in Dar es Salaam, a process that would take five years.
"If those guys don't come back," Ellegala
told Word, "then I think all we've done with Madaktari
is for nothing.
"It's an epiphany for me too," Ellegala
So many nonprofits successfully raise money to build new clinics and schools but fail to cultivate leaders.
For the first time, he
saw clearly how Madaktari
could provide a lasting way to improve a poor country's health care system.
"We try to help create people locally who do what we do, carry on the knowledge and then become leaders beyond us."
What of Haydom?
and Word were heartened to hear that Nuwas would go back to Haydom