Sustainable Healthcare Change in Africa

Train and Teach to Train

A neurosurgeon at the Medical University of South Carolina shows how one person can make an impact and bring some of the leading institutions in the world together to empower others.

Tanzania has just three neurosurgeons; a ratio of one per 12.9 million people. The World Health Organization recommends one neurosurgeon for every 100,000 people in order to provide an adequate level of treatment. In the United States there are an estimated 4,000 practicing neurosurgeons.

MUSC Dr. Ellegala Travels to Tanzania
When Dilan Ellegala, finished his fellowship in neurosurgery, he took six months off to volunteer his medical services at Haydom Lutheran Hospital in northern Tanzania.   What he observed was traditional medical missions providing aid to the community instead of investing in training the local people — creating a continued cycle of dependency on foreign resources and expertise.

Inside a Rural Village Hospital

Once at Haydom, family members crowd in one room, caring for their loved ones, and cooking food over open fires. The operating room consists of a doctor, and a nurse as well as a person to hold a fly-swatter to kill any insects that come in and to hold a flashlight when electricity comes and goes.  There is no ventilator to keep the anesthetic flowing, and a nurse manually pumps the chemical.  When the nurse becomes tired, it is not uncommon for a family member to take over.

A staff member wheels in a seven-year-old child with advanced retinoblastoma – a condition that would have been detected in the early stages in the Western world.  The tumor has ruptured through the eyesocket and all doctors can do is remove the tumor to ease the patient’s suffering.

“We need to invest in the Tanzanian people by empowering them with the medical skills they need to take care of their own community. When missions leave, the community is reliant on the next group to care for their patients, the next piece of equipment that might come in .. .but nothing permanent left behind,” said Ellegala.

Dr. Ellegala Takes an Apprentice

Ellegala decided to change things when he met Myegga, a local villager who grew up in a mud hut but who had worked hard to become a clinical officer.  The education level of the Tanzanian medical staff is about the equivalent of a high school education plus two years of medical technical training.  Myegga had no surgical training but an eagerness to learn.

Ellegala trained Myegga in six months how to perform neurosurgery, first together, then alone, then overseeing him train another Tanzania.  Ellegala taught using available resources.   For example, he bought a wire saw from a villager who was cutting down a tree, sterilized it and taught them how to use it in surgery for a craniotomy and turned an IV into a makeshift shunt.

Madaktari Africa – A New Model Is Born
Ellegla was so moved by his experience in Haydom that he organized Madaktari , a non-profit program in Tanzania.  The program works with the Ministry of Health and all the regional hospitals throughout the country to create sustainable healthcare in East Africa.  The concept:  Train and then train to teach. Trained surgeons, nurses, biomedical engineers go to East Africa to teach and share their knowledge and the African neurosurgeons visit the U.S. to observe techniques and procedures.

Through the support of MUSC as the coordinating site for Madaktari,  Ellegala has brought several leading institutions on board including the Barrow Neurological Institute, Harvard Medical School, Brigham and Women’s Hospital, University of Colorado, Duke Medical University, Cornell Medical College, The University of Bergen in Norway and Valencia, Spain.
This innovative model is so far proving successful.

“Neurosurgery is only a pilot program.  We are quickly finding positive results that show us this model can work for maternal health, pediatrics and basic surgery.  This is truly geared to training healthcare workers in East Africa in their homeland,” said Ellegala.

In just a few years, Madaktari has trained more than 10 doctors in four African countries.

Sunil Patel, MD, Clinical Chair of the Department of Neuroscience, said, “It’s train somebody and then the next step is train them to train others.  Improving a highly specialized technique such as neurosurgery in Africa will raise standards for all forms of health care – better nursing care, anesthetics, doctors and technicians.

Hear Dr. Patel talk about the importance of teaching the next generation of doctors.