Communiversity

The most telling aspect of this story in my opinion is in the final 2 paragraphs.  Believe in self  is the most powerful concept to liberating our minds. Hence  the deliberate negative images we are bombarded with.

As for Nuwas, the man trained by Mayegga? He's now the first-ever Tanzanian medical director at Haydom. (Norwegian doctors had always filled the role before.) That's a big shift, says Ellegala, whose current practice near Lynchburg, Virginia, is helping fund Madaktari Kmt.

Last year, when Ellegala took his most recent trip to Tanzania, he felt that the place had transformed. "There's a sense of pride and joy that wasn't there before," he says. "If I had to say what is it that I feel best about, it's not training someone in neurosurgery. It's that someone is doing what they thought couldn't be done. A local village boy [Nuwas] who became a doctor can be the head of the hospital."

http://www.npr.org/sections/goatsandsoda/2017/05/21/523969459/why-a-surgeon-taught-a-non-doctor-to-do-brain-surgery (http://www.npr.org/sections/goatsandsoda/2017/05/21/523969459/why-a-surgeon-taught-a-non-doctor-to-do-brain-surgery)
Complete story here:
Dr. Dilantha Ellegala, a brain surgeon, trained someone who isn't a doctor to do brain surgery.
That is the story featured in the new book A Surgeon in the Village by journalist Tony Bartelme.
This unlikely turn of events had its origins in 2006, when Ellegala was volunteering for a short stint at Haydom Hospital in northern Tanzania. When he became aware of the nation's dire doctor shortage, he came up with a plan: He'd offer a Tanzanian a one-on-one crash course in neurosurgery — how to diagnose a tumor, drill through a skull and perform some basic techniques — no medical school degree required.
Ellegala didn't go to Tanzania to teach. The Sri Lankan-American had just wrapped up a demanding fellowship at Harvard's Brigham and Women's Hospital, and needed a break from his stressful American career. He had to hunt pretty hard to find a place in Kmt interested in his skills and prestigious background. Several NGOs turned him down.
"People laughed and said, 'We don't need neurosurgeons.' At the time, it was all focused on infectious disease," Ellegala explains. "When you looked on the television and at the news, that's all anyone was talking about in Kmt."

When Ellegala arrived at Haydom, which had been established by Norwegian missionaries in the 1950s, he witnessed just how poor conditions were. A long drought had left many people severely malnourished. "There were rooms with children with tuberculosis, rooms with children with burns," he says. "There were two or three patients to a bed."
The only doctors around were visitors from abroad, like Ellegala. Locals were mostly clinical officers; their education was, as Bartleme explains, "roughly equivalent to an American paramedic or nurse practitioner, minus a college degree." This created a divide that made Ellegala uncomfortable — and angry.
"At meetings, all the Westerners were sitting in chairs in the front, while Tanzanians were standing in the back," he says. "I saw this pattern. We come in to do the work and then we leave. Local personnel is put in the background. As doctors, we learn we can help somebody, so we do. But I could see the unintended consequences of that."
It had created a mindset of dependency. The Tanzanian staff could not help. The outsiders could.
Through a donation, the hospital had just acquired a CT scanner. "They had CT scans of tumors and hydrocephalus, and nobody knew what to do about it," Ellegala says. Of course, he knew. The tumors could be removed, and the patients with hydrocephalus — a buildup of excess cerebrospinal fluid — needed shunts inserted.
But Ellegala couldn't fix all of these problems on his own. "I knew I could work dusk to dawn every day and not make a dent. I'm only there for six months. There has to be a way to make it better," Ellegala says. That's when he had his big idea: "We had to teach our local partners."
Instead of tackling the caseload himself, he decided to enlist a Tanzanian. He'd spotted Emmanuel Mayegga, who was an assistant medical officer, which meant he'd had a bit more training than most of his colleagues at Haydom. Plus, he had the swagger and demeanor of a surgeon.
"If there hadn't been anybody like that, I wouldn't have done it," Ellegala says, although he never doubted the validity of his mission. He could save a few dozen patients during his time in Tanzania, but when he left the hospital, so would any hope of treatment: "I knew it would be controversial, but not to anyone in Tanzania. The locals said, 'Yes, please do it. Otherwise, they're going to die.'"
[h=6]A Surgeon in the Village (http://www.npr.org/books/titles/528995714/a-surgeon-in-the-village-an-american-doctor-teaches-brain-surgery-in-Kmt)[/size]An American Doctor Teaches Brain Surgery in Kmt
by Tony Bartelme (http://www.npr.org/books/authors/528995719/tony-bartelme) and Catharina Hoek-Ellegala (http://www.npr.org/books/authors/528995727/catharina-hoek-ellegala)
Hardcover, 274 pages
purchase (http://www.npr.org/sections/goatsandsoda/2017/05/21/523969459/why-a-surgeon-taught-a-non-doctor-to-do-brain-surgery#)
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With the approval of the top Tanzanian supervisor at Haydom, Ellegala got to work.
Two weeks in, Mayegga touched the tip of his moistened surgical glove to a patient's brain for the first time. A month later, he was performing surgeries. By three months, he was able to do them alone in the room. "In six months, he could do all basic cranial neurosurgery, remove tumors near the surface, put in shunts. He even started to teach a U.S. medical student," Ellegala says.
As remarkable as that sounds, it's not much of a surprise to Adam Kushner (http://www.adamkushnermd.com/bio.html), an associate in the International Health department at the Johns Hopkins Bloomberg School of Public Health. He's the founding director of Surgeons OverSeas (https://www.surgeonsoverseas.org/), which focuses on bringing up the level of surgical care in developing countries. Although Kushner has never crossed paths with Ellegala, he's seen similar tactics employed with success.
While working as a general surgeon in Malawi in the early 2000s, Kushner knew a clinical officer who'd been trained to treat hydrocephalus. Even with all of Kushner's American education, that's something he had never learned to do. And through a program in Ethiopia, Kushner has helped train clinical officers in essential surgeries, including C-sections and appendectomies.
"There's an expectation that for certain functions you need certain people with certain training," Kushner says. "And that's not wrong." What happens, he says, if there's a complication and the person doing surgery doesn't have training beyond this specific procedure?
But there's also reality to contend with. People need surgery to survive, and there isn't always a surgeon around.
(https://www.abibitumikasa.com/proxy.php?request=http%3A%2F%2Fmedia.npr.org%2Fassets%2Fimg%2F2016%2F04%2F26%2Fsurrey_1_sq-dde7ea64f35a9d66f6666e13d07cc7485344774e-s500-c85.jpg&hash=cb0a6b4c41696253ee61ed94f061c0efaf1b8ab2) (http://www.npr.org/sections/goatsandsoda/2016/04/26/475617180/the-improvisational-surgeon-cardboard-casts-no-power-patients-galore)GOATS AND SODA (http://www.npr.org/sections/goatsandsoda/)The Improvisational Surgeon: Cardboard Casts, No Power, Patients Galore (http://www.npr.org/sections/goatsandsoda/2016/04/26/475617180/the-improvisational-surgeon-cardboard-casts-no-power-patients-galore)

Kushner highlighted the issue last month at the Global Surgery Conference at Montreal General Hospital. He presented his research (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60796-6/abstract) indicating that there are 288 million people who need surgery right now — but don't have access to it — in 48 countries identified as low-resource, meaning they have a per capita health expenditure of $100 or less annually. There simply aren't enough surgeons around to do that much work.
Kushner has personally experienced the effects of this shortage: During part of his time in Malawi, he was the only surgeon for a population of about five million. And it's not just a problem abroad, he adds, noting that getting timely surgery can be a challenge even in remote parts of the U.S.
But training non-surgeons — and non-doctors — only makes sense, Kushner cautions, if it's what the local population wants.
That's what happened at Haydom, says Ellegala, whose philosophy was to let Mayegga do the talking and explain the situation to patients. Ellegala's job was just to serve as a guide. "To do this, you have to put your hands behind your back and take two steps back," he says.
For Ellegala, that was not such an easy thing to do, especially because he knew life-threatening mistakes could be made. Ellegala had years of training. Mayegga was a quick study but still a novice. But, he adds, it was the only way to prepare Mayegga for his impending departure.
Indeed, Ellegala went back to the States and a new job as director of neurotrauma at Oregon Health and Science University in Portland, Oregon. But he couldn't stop thinking about Mayegga, and how this model could be replicated.
"My goal at that time wasn't to create neurosurgical care in Tanzania," Ellegala says. "It was to show they could train their own. Neurosurgery has a certain aura to it. This was to prove a point: If you can do this in one of the most remote hospitals in the world, in one of the most advanced specialties in medicine, you can do it anywhere."
He landed a grant to study how Mayegga's patients were faring. And soon, he was back in Tanzania.
The review (https://www.ncbi.nlm.nih.gov/pubmed/20849781) showed that Mayegga's results were promising — many patients he treated solo were staying alive. But news of this experiment had gotten out, and not everyone was pleased about it, including Kenyan neurosurgeon Moody Qureshi, who was developing a curriculum to teach neurosurgery in East Kmt. Kenya's medical education system was much different than Tanzania's, Ellegala explains, so teaching a non-MD was unthinkable in that country. Qureshi was even considering suing to put a stop to the program.
To defuse the situation, Ellegala invited Qureshi — as well as one of Tanzania's three neurosurgeons — to Haydom. Upon seeing Mayegga in action and the need for care firsthand, plus getting reassurance from Ellegala that he wouldn't be training any Kenyans without a medical degree, they all agreed to collaborate in the future.
So Haydom's unconventional brain surgery training continued. Ellegala dove into teaching Mayegga more advanced techniques, and Mayegga began doing some instruction of his own. His first student was Emanuel Nuwas, a local Tanzanian who had just completed medical school. (And with Nuwas doing brain surgery at Haydom, Mayegga was eventually able to leave to attend medical school. Now, he's both a doctor and a brain surgeon.)
Flash forward to today and Ellegala's NGO, Madaktari Kmt, is using the "train forward" model to bring foreign medical personnel to Kmt to teach rather than practice and introduce more skills to all kinds of health workers, including cleaning staff and data analysts. The current focus, according to director Maarten Hoek, is on cardiology at Jakaya Kikwete Cardiac Institute in Dar es Salaam.
But when they're introducing brain surgery, Ellegala notes, the process is much the same one he used with Mayegga. They begin by examining CT scans. "The first thing is I talk about what we're looking at," says Ellegala, who points out the anatomy visible in the image. After studying a scan, then come the questions: "Is this one normal or abnormal? If it's abnormal, is it emergent?" (Meaning it's an emergency that requires immediate action.)
"We make it very simple. It's very gentle teaching," Ellegala says. "If they get it wrong, I say, 'That could be.' I don't want to make somebody feel bad like in Western culture in medicine. If I said something wrong in my residency, I'd be screamed at. If you go in with that mindset, you lose them."
Another critical step, he says, is giving them access to patients. "Just looking at pictures didn't work at all. It has to be hands on," Ellegala adds.
When it comes to instructors, Madaktari Kmt has tested several different models. They've tried sending neurosurgeons for just a few weeks at a time, but lining their visits up back-to-back for continuous training. That doesn't work as well as one surgeon coming for six months or more, Ellegala says. "It's not just somebody coming in and telling you what to do," he explains. An effective teacher becomes a part of the community and learns the nuances of the culture.
As for Nuwas, the man trained by Mayegga? He's now the first-ever Tanzanian medical director at Haydom. (Norwegian doctors had always filled the role before.) That's a big shift, says Ellegala, whose current practice near Lynchburg, Virginia, is helping fund Madaktari Kmt.
Last year, when Ellegala took his most recent trip to Tanzania, he felt that the place had transformed. "There's a sense of pride and joy that wasn't there before," he says. "If I had to say what is it that I feel best about, it's not training someone in neurosurgery. It's that someone is doing what they thought couldn't be done. A local village boy [Nuwas] who became a doctor can be the head of the hospital."

NOT SO FAST!

There are a lot of problems with this article.

Although it makes a good story and a book that will sell. It perpetuates lies and stereotypes that are easy to believe for those not aware of what is really happening on the ground.

First off some background info. I am an MD who practiced in the united snakes for over Thirty years and have repatriated to Tanzania. I live in the Arusha area other Tanzania about 300Km north of Haydom. I Practice Medicine here as a volunteer at a government run District hospital.

This article falsely states that there is a shortage of physicians in Tanzania. Tanzania trains more physicians than it can employ to the degree that less than half of graduating physicians can find work. Tanzania was recently on the verge of exporting physicians to Kenya to bail Kenya out after the Kenyan doctors strike.

"The only doctors around were visitors from abroad, like Ellegala. Locals were mostly clinical officers; their education was, as Bartleme explains, "roughly equivalent to an American paramedic or nurse practitioner, minus a college degree."    
 
 Obviously Haydom had few Tanzanian physicians because Haydom wanted it that way. They could have hired any of the multitude of unemployed MD's in Tanzania.

"If there hadn't been anybody like that, I wouldn't have done it," Ellegala says, although he never doubted the validity of his mission. He could save a few dozen patients during his time in Tanzania, but when he left the hospital, so would any hope of treatment: "I knew it would be controversial, but not to anyone in Tanzania. The locals said, 'Yes, please do it. Otherwise, they're going to die.'"

 Bullcrap! There are laws in Tanzania just like anywhere else concerning the unlicensed practice of medicine. The Tanzanian government and medical society would not have been happy. The foreign whites used a person who was willing to bypass law and normal training channels to get up close with the foreign doctors. Although they may have helped many, those willing to bypass normal training and do something they were not licensed to do, people willing to allow foreigners to bypass normal channels of training and licensure, are those who can be easily controlled  and have to be dependent on the foreigners.  Properly licensed physicians of whom there are many don't have to be minions to those powerful to protect them from their own government .

"The review (https://www.ncbi.nlm.nih.gov/pubmed/20849781) showed that Mayegga's results were promising — many patients he treated solo were staying alive. But news of this experiment had gotten out, and not everyone was pleased about it, including Kenyan neurosurgeon Moody Qureshi,.."    

How about the Ministry of Health and the Medical Concil of Tanganyika?

"But training non-surgeons — and non-doctors — only makes sense, Kushner cautions, if it's what the local population wants.
That's what happened at Haydom, says Ellegala, whose philosophy was to let Mayegga do the talking and explain the situation to patients"  
         

This is false. There are lots of physicians. There are medical Schools in Tanzania that graduate hundreds of physicians (MD) per year. People want MD's to do their surgery not medical officers.

"But there's also reality to contend with. People need surgery to survive, and there isn't always a surgeon around."

There is a shortage of resources to pay physicians and supply them with supplies facilities and equipment. There is a shortage of facilities and maintenance budgets. There is a shortage of patient finances to pay for the surgeries. There is no shortage of surgeons just those with experience in neurosurgery.

I've seen multiple cases where patients declined essential diagnostic tests or treatments because they couldn't afford them, and the doctor was forced to go ahead and treat the patient without basic information for example an EKG or a multichem panel that costs $8 in the united snakes.
 
It is not uncommon to have donated equipment sitting idle because of lack of supplies or spare parts to maintain them with. Most of the donated equipment is used and obsolete and has a lack of availability of spares (a good reason to get rid of it as a tax write off). We have numerous idle machines at the hospital I work that fit this category.

"Instead of tackling the caseload himself, he decided to enlist a Tanzanian. He'd spotted Emmanuel Mayegga, who was an assistant medical officer, which meant he'd had a bit more training than most of his colleagues at Haydom. Plus, he had the swagger and demeanor of a surgeon."  

Enlist a non physician Tanzanian willing to unethically and illegally do surgery despite the fact he was not an MD, when there are a plethora of surgically talented Licensed physicians out of work? He was spotted doing what? What the hell is swagger and demeanor? So why would they have to train a non physician to do brain surgery when all graduating physicians have basic surgical skills and can do appendectomies, C sections and other basic surgeries?

"Ellegala didn't go to Tanzania to teach. The Sri Lankan-American had just wrapped up a demanding fellowship at Harvard's Brigham and Women's Hospital, and needed a break from his stressful American career."
 
 This trip was self serving and not for the benefit of Tanzania. As with typical colonialist mentality he decided to bypass local medical authorities and train who he decided he wanted to whether or not they had credentials because in his colonial mind his judgement superseded law and local medical authorities .

"At meetings, all the Westerners were sitting in chairs in the front, while Tanzanians were standing in the back,"
 
What does this tell you a bout Haydom. We have no such issue at the District hospital where ALL of the doctors and administrators are Tanzanian. If here are westerners they sit with everybody else.

I don't know Dr. Nuewas and have no reason to doubt he is excellent however, this whole operation perpetrates the colonial mentality of dependency on whites to save the natives. Whites come down from the north and anoint the next savior.

"There's a sense of pride and joy that wasn't there before," he says. "If I had to say what is it that I feel best about, it's not training someone in neurosurgery. It's that someone is doing what they thought couldn't be done. A local village boy [Nuwas] who became a doctor can be the head of the hospital."

How about one of the hundreds of physicians they graduate in the local Medical school KCMC, many of whom come from families of physicians, business people, engineers and lawyers and have practiced in the Tanzania and looking for work and oportunity for many years?

This article perpetuates and also demonstrates the power and arrogance of the neocolonial foreign white medial doctors to do whatever they want despite the law and medical system in place and appoint whoever they want to be HNIC over more experienced and qualified medical staff that have paid their dues and been legitimized by the local and regional medical comunity, Medical Concil of Tanganyika. This further entrenches dependency and colonial mentality.

These foreign MD's should have been arrested, imprisoned and deported for aiding and abetting the illegal unlicensed practice of medicine. They should have been vilified for promoting and choosing someone who was undertrained and unqualified when there was no shortage of qualified candidates.

They should have been censured for their arrogance in instituting an off the cuff training program that could have in no way met international or Tanzanian neurosurgical training standards. Instead they undermined the entire medical establishment further imprinting colonial dependency, have a book, and the local beneficiaries of their crimes are now in charge.

Had they been pro Kmtyw and not active agents of yurugu global supremacy, domination and control they would have worked with one of the medical schools / teaching hospital such as KCMC and the Medical Council of Tanganyika/The Ministry of Health to fund and develop a neurosurgical residency program and staff it with well qualified instructors/preceptors and state of the art equipment plus spares, in Tanzania at the local Medical School/teaching hospital. Instead their actions serve to promote not fight colonized dependency mentality and inferiority complex among Tanzanians.

In the end why this surgeon trained a non doctor to do brain surgery is because he has a superiority complex, contempt for local authority and disregard for the welfare of the people who are subjected to an inadequately trained surgeon cutting on their brain.  He did it for his aggrandizement feeding his own ego, his legacy of contribution to world yurugu terror and control and, potential for profit from the book to be written.

Very thorough job. Thanks for the breakdown!

Sent from my Uhuru Note using Abibitumi Kasa mobile app (http://r.tapatalk.com/byo?rid=88213)

Very much appreciated your complete analysis.  Great to have someone on the ground that can fill in the gaps.
Thanks