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A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa

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A Surgeon in the Village tells the true story of Dr. Dilan Ellegala's quest to teach brain surgery in one of the poorest and most remote places on earth. In vivid detail, the book also exposes one of the world's most neglected but serious public health problems - one that kills more people than malaria, tuberculosis and AIDS combined. A Surgeon in the Village tells the true story of Dr. Dilan Ellegala's quest to teach brain surgery in one of the poorest and most remote places on earth. In vivid detail, the book also exposes one of the world's most neglected but serious public health problems - one that kills more people than malaria, tuberculosis and AIDS combined.


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A Surgeon in the Village tells the true story of Dr. Dilan Ellegala's quest to teach brain surgery in one of the poorest and most remote places on earth. In vivid detail, the book also exposes one of the world's most neglected but serious public health problems - one that kills more people than malaria, tuberculosis and AIDS combined. A Surgeon in the Village tells the true story of Dr. Dilan Ellegala's quest to teach brain surgery in one of the poorest and most remote places on earth. In vivid detail, the book also exposes one of the world's most neglected but serious public health problems - one that kills more people than malaria, tuberculosis and AIDS combined.

30 review for A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa

  1. 5 out of 5

    Diane S ☔

    After thirteen years of medical school, learning to be a neurosurgeon, Dr. Dylan Ellegala is suffering from severe burnout. He decides to take six months to determine where he wants to go next with his career, and decides to go to Tanzania as a visiting doctor. He finds the country has only three brain surgeons for its population of forty two million. Lack even the basic supplies of surgery and where many die from conditions that could be corrected by even the most basic surgery. While here he m After thirteen years of medical school, learning to be a neurosurgeon, Dr. Dylan Ellegala is suffering from severe burnout. He decides to take six months to determine where he wants to go next with his career, and decides to go to Tanzania as a visiting doctor. He finds the country has only three brain surgeons for its population of forty two million. Lack even the basic supplies of surgery and where many die from conditions that could be corrected by even the most basic surgery. While here he must improvise, using a tree saw from a farmer and saves a man's life. There are other things he will change while here but the most important is the realization that these visiting doctors will leave, himself included and the country will be no better off. He realizes that if he teaches even basic surgery to the medical clerks that have the right attitude, willingness to learn and the stamina to succeed, he will have accomplished much more than he set out to do. Such a wonderfully enlightening story, not just about the conditions in these forgotten countries, where there is so much sickness and so few doctors, but about the medical establishment as a whole. As the book notes, in my own country, trade groups and researchers incorrectly forecasted a doctor surplus. Our illustrious and knowledgeable Congress (please recognize this as sarcasm) put a cap on residency slots. Of course, as they often do, they made the situation much worse, because now by the year 2020, my country will have an estimated deficit of ninety thousand doctors. Appalling. So what do we do? We recruit them from other countries that need these doctors much more than we do, we save money from the doctors we don't have to train, and of course their salaries are much higher here. Please note: the U tied States is not the only country doing this.) So enlightening this book, well told and as with any book about social injustice, made me extremely angry. I gained much more from this book than I originally anticipated when I chose it to read. ARC from Librarything. Publishes March 28th by Beacon Press.

  2. 5 out of 5

    Diane Barnes

    Excellent book of research and reportage by Tony Bartelme. An American neurosurgeon goes to a village in Tanzania to decompress after 15 years of medical school and residency. He reluctantly gets involved in hospital cases in Haydom, and eventually improves not just his life, but, by teaching what he knows, eventually under-doctored people all over the world. This is not my usual reading material at all. I read it because the author works as a reporter for our local newspaper, The Charleston Post Excellent book of research and reportage by Tony Bartelme. An American neurosurgeon goes to a village in Tanzania to decompress after 15 years of medical school and residency. He reluctantly gets involved in hospital cases in Haydom, and eventually improves not just his life, but, by teaching what he knows, eventually under-doctored people all over the world. This is not my usual reading material at all. I read it because the author works as a reporter for our local newspaper, The Charleston Post & Courier and he has consented to participate in person for our book club meeting in July. I was amazed to find myself reading avidly and loving even the smallest details on life in Africa and brain surgery without proper equipment. Excellent!

  3. 4 out of 5

    Phyllis

    This very inspirational true story is about Dr. Dilan Ellegalla who was born in Sri Lanka and he and his family moves to the US so he can become a doctor. Even at the young age of six he knows what he wants.After medical school and a residency in neurosurgery he heads to Tanzania and discovers that the country with over 40 million people has only 3 neurosurgeons. The book follows what happens as he tries to teach brain surgery in a hospital with no supplies to do this kind of surgery. Amazing do This very inspirational true story is about Dr. Dilan Ellegalla who was born in Sri Lanka and he and his family moves to the US so he can become a doctor. Even at the young age of six he knows what he wants.After medical school and a residency in neurosurgery he heads to Tanzania and discovers that the country with over 40 million people has only 3 neurosurgeons. The book follows what happens as he tries to teach brain surgery in a hospital with no supplies to do this kind of surgery. Amazing doctor and human being. Very well written.

  4. 5 out of 5

    Paul McFarland

    A Surgeon in the Village tells three interconnected stories in a readable, exciting, fashion. First, the personal story of Dilan Ellegala who, born in Sri Lanka, traveled to South Dakota when he was six. He grew up there with a fixed desire to become a doctor. After years of school, he arrived at a neurovascular fellowship at Harvard Medical School. At the end of this training, he had job offers from several major neurosurgical centers He decided to postpone starting his practice for six months. A Surgeon in the Village tells three interconnected stories in a readable, exciting, fashion. First, the personal story of Dilan Ellegala who, born in Sri Lanka, traveled to South Dakota when he was six. He grew up there with a fixed desire to become a doctor. After years of school, he arrived at a neurovascular fellowship at Harvard Medical School. At the end of this training, he had job offers from several major neurosurgical centers He decided to postpone starting his practice for six months. Against the advice of almost everyone around him, he decided to travel to Africa, to a small hospital in Tarzana. He intended to mostly rest and read to unwind from the pressure of a neurosurgical education. However, in Tarzana at Hayden Lutheran Hospital, he found himself pulled into the work. He would practice on and off there for years. Later he met and married his wife Carin who was another physician who came to work there. The second story intertwined with the first shows the development and molding of a neurosurgeon. Many physicians mentored him. He was most affected when a surgeon told him to continue a procedure on the brain. When he reminded the neurosurgeon that he was only a student the doctor told him to go right ahead, that anything that he messed up the surgeon could fix. This attitude of almost cocky self-confidence he found to be part of the profession. Neurosurgeons were the rock stars of medicine. But to achieve that goal required a single-minded focus on the job, and nothing but the job, for an eight-year residency and a yearlong fellowship. From the time he touched the tip of a gloved and moistened finger to a living brain, he was hooked. This was where it was at. This was how things were fixed. You opened the head, and then you could see the problem. Cures were made with steel and suture. Always fighting time – time was brain. The longer a surgery or a problem lasted, the more the possibility of permanent loss. He described a patient with an arrow piercing his head. The barb of the arrow was almost hooked around a major blood vessel. He studied the CT scan and then with the perfect visualization that came from years of study and practice he pushed, turned, and lifted just so, then pulled the arrow straight out. A two-second task that took a decade and a half to prepare for. In the third, and perhaps most important part of the book, he describes the problem he found in Africa. The huge amount of medical aid was making the situation worse. Sending local students away to be trained as physicians resulted in them being poached by first world hospitals. No one, not even the US, has enough doctors. He presented his solution; to teach not do. A doctor spending a few months doing surgery or practicing medicine in an area helps only people who were lucky enough to be the right kind of sick when the right kind of doctor was there. The physician should become part of an effort to educate local people to take charge of their own healthcare. He started this effort by training a medical officer, basically a third-year medical student, to do the most common neurosurgical procedures and to inspire his student to find and teach a student of his own. From this start, he founded the NGO (Non-Governmental Organization) named Madaktari (Swahili for doctor) to promote this train forward philosophy. As an RN I enjoyed this book hugely and recommend it highly. The author explains everything as he goes along and it is accessible to everyone. A most enjoyable and downright good book.

  5. 5 out of 5

    Rob

    Excellent read, neurosurgeon from Lynchburg, VA is the main character in this true story.

  6. 5 out of 5

    Gordon Paisley

    Review of A Surgeon in the Village by Tony Bartelme I don’t often read memoirs, but the idea of a neurosurgeon practicing in a rural hospital in Tanzania--a country with only a handful of neurosurgeons, was just too intriguing. I’m pleased to say that the book did not disappoint. Dr. Dilan Ellegalla is a Sri Lankan-born, US-raised neurosurgeon. After completing his residence, he decided to spend six months visiting Haydom Lutheran Hospital in rural Tanzania. While he originally went with the inten Review of A Surgeon in the Village by Tony Bartelme I don’t often read memoirs, but the idea of a neurosurgeon practicing in a rural hospital in Tanzania--a country with only a handful of neurosurgeons, was just too intriguing. I’m pleased to say that the book did not disappoint. Dr. Dilan Ellegalla is a Sri Lankan-born, US-raised neurosurgeon. After completing his residence, he decided to spend six months visiting Haydom Lutheran Hospital in rural Tanzania. While he originally went with the intent of relaxing, he soon saw that the hospital was forever at the mercy of visiting doctors because they never were able to train their own local doctors to do surgery. This book is the story of how Dr. Ellegalla undertook to change that. Along the way, we not only see his passion for teaching and developing local doctors, we also come to understand the dilemma of foreign-funded hospitals and nonprofits in the developing world and how they are so often (and probably usually inadvertently) kept at the mercy of their sponsors because they never develop local talent. We also get a light introduction to surgery and brain surgery in particular. Although it is usually not too detailed, it does contain some medical details that may bee too much for some readers. There are parts that feel a little repetitive, especially some of the conversations Dr. Ellegalla has with himself over what he should do, but they ultimately do not detract from the book. Most of the writing was so compelling, I found myself thoroughly engrossed on my train ride commute--completely losing track of time. The setting and time jumped around enough to keep the story interesting and coherent. If you have an interest in medicine or in medical nonprofits or in developing Africa, then this book will be inspiring to you. I am not a physician, although I know people who are medical professionals in Africa and they are doing a huge work to teach and grow local medical talent so the people will not be forever dependent on western expertise. This was a pleasure to read that surprised me by being even better than I expected. Disclosure: I received a complimentary copy of this book from the publisher with the expectation I would provide an honest review.

  7. 4 out of 5

    Jill Dobbe

    An inspiring, honest, and emotional memoir about three doctors working as neurosurgeons in Tanzania. Dr. Dilan Ellegalla felt the desire to go to Africa after completing his long residency and while there saw the incredible need for neurosurgeons. He used his skills and knowledge to teach one doctor, and that doctor trained another, and it continued as Ellegalla began a crusade of teaching and training doctors in neurosurgery. I wanted to read this book the moment I heard about it. A book always An inspiring, honest, and emotional memoir about three doctors working as neurosurgeons in Tanzania. Dr. Dilan Ellegalla felt the desire to go to Africa after completing his long residency and while there saw the incredible need for neurosurgeons. He used his skills and knowledge to teach one doctor, and that doctor trained another, and it continued as Ellegalla began a crusade of teaching and training doctors in neurosurgery. I wanted to read this book the moment I heard about it. A book always means more when you can relate your own life to what the author writes about. I have a son in his second year of medical residency who is planning to go to Kenya next year as part of the hospital's international program, and my family and I lived in West Africa for five years. While reading A Surgeon in the Village, I gained incredible insights into what it's like to be a resident, as well as the difficulty in working in the medical field in Africa. Also interesting, was how the doctors and nurses in Tanzania viewed those foreign medical personnel (like my son) who came for a few weeks or months, and then left. The author gave readers detailed technical information about the brain and surgical procedures throughout the book, but also details of the doctors' lives, families, and home situations giving the book a touching and humanistic approach. A Surgeon in the Village was an amazing read. I am indebted to the author for sending me this well written book that I will surely pass on to my son and others. Thank you Tony Bartelme for making me a little smarter about the medical field within the U.S. and Tanzania.

  8. 5 out of 5

    Kathleen Gray

    Educational for sure but more importantly inspiring. This is a wonderfully written down to earth plea to re-imagine how we provide aid around the world. Dilan's experience is in neurosurgery but that's not his only impact in Tanzania and hopefully in the international medical community. Thanks to Edelweiss for the ARC. I don't know what to say expect to highly recommend this for those interested in the global aid experience or in medical stories. This was terrific! Educational for sure but more importantly inspiring. This is a wonderfully written down to earth plea to re-imagine how we provide aid around the world. Dilan's experience is in neurosurgery but that's not his only impact in Tanzania and hopefully in the international medical community. Thanks to Edelweiss for the ARC. I don't know what to say expect to highly recommend this for those interested in the global aid experience or in medical stories. This was terrific!

  9. 4 out of 5

    Lana

    Love how Dilan worked to transform medical practices in humanitarian missions and help others help themselves! Great ideas, great book! "This is the completion of a cycle for me. They're all doing neurosurgery. They're all leaders, but they're leading in different ways. They're showing what happens when people change the way they think about themselves." p. 263 Love how Dilan worked to transform medical practices in humanitarian missions and help others help themselves! Great ideas, great book! "This is the completion of a cycle for me. They're all doing neurosurgery. They're all leaders, but they're leading in different ways. They're showing what happens when people change the way they think about themselves." p. 263

  10. 5 out of 5

    Aviv

    The book was outstanding, fantastic, inspirational! A must read again and again! Btw, thanks Goodreads for giving this book to me free of charge. The federal government is now headed by a jackass so I must keep writing this in my giveaway reviews.

  11. 4 out of 5

    Michele Weiner

    Tony Bartelme is a world-class investigative reporter for my local newspaper who has been nominated for a Pulitzer three times so far. He has written half a dozen books and ebooks and likes to talk about how his investigations give him passports into new areas of being. This time, it's medicine. He describes the life and career of Dr. Dilan (rhymes with Milan) Ellegala, top neurosurgeon, but a man who always knows that working too hard results in the need to take some time off. He is smart, intu Tony Bartelme is a world-class investigative reporter for my local newspaper who has been nominated for a Pulitzer three times so far. He has written half a dozen books and ebooks and likes to talk about how his investigations give him passports into new areas of being. This time, it's medicine. He describes the life and career of Dr. Dilan (rhymes with Milan) Ellegala, top neurosurgeon, but a man who always knows that working too hard results in the need to take some time off. He is smart, intuitive, inventive, and unafraid to try what has not been tried before. Dr. Ellegala goes to Tanzania on a medical mission, to clear his mind, take some rest, and do some neurosurgery at a small village hospital built and maintained by a Norwegian church for the benefit of the native people. Dilan is appalled by the lack of surgeons and equipment, but is also stunned by the quality of the half-trained medical assistants he finds working in the hospitals. After deciding that it would be better to teach the best candidate already working at the hospital than to do the surgery himself, Dilan begins to train Emmanuel. The breakthrough comes when Dilan teaches Emmanuel to teach his own student, and soon there is proper equipment and many lives are saved. We follow Dilan through the growing pains of his organization, which he has now handed off to some MUSC cardiologists whose emphasis is not on neurosurgery at all. Great story about a talented man written by a talented man.

  12. 5 out of 5

    nicole

    I first saw this book on the shelves at my local library and for some reason I picked it up, despite all the many unread books waiting on my shelves at home. I cracked open the book and was immediately drawn in. I decided to check it out and am so glad I did. Tony Bartelme does a great job of weaving together the inspiring story of Dr. Dilan Ellegala, an American neurosurgeon of Sri Lankan descent, and his quest to improve the state of medical care worldwide. He adds just the right amounts of pu I first saw this book on the shelves at my local library and for some reason I picked it up, despite all the many unread books waiting on my shelves at home. I cracked open the book and was immediately drawn in. I decided to check it out and am so glad I did. Tony Bartelme does a great job of weaving together the inspiring story of Dr. Dilan Ellegala, an American neurosurgeon of Sri Lankan descent, and his quest to improve the state of medical care worldwide. He adds just the right amounts of public health facts, personal stories and insight into each character, faults and all, we meet in this story. As someone who has been a neurosurgery patient, I found the details about the different neurosurgeries fascinating. The book had a bit of everything, raising awareness about worldwide health issues, individual character development and stories of love and devastation. Bartelme draws the reader into this account of success and inspiration without leaving out the real struggles and failures of the characters. I'm finding myself wondering about looking into some of Bartelme's other books.

  13. 5 out of 5

    Michelle Ule

    As the mother of an EMT currently pursuing a Master's in Global Medicine Management, I picked up this book with interest. My daughter hopes to spend time in Africa this summer, as well as her sixth trip to Nicaragua for a church eyeglass ministry. I learned a lot and am thankful. Bartelme is a fine writer and does a splendid job telling the story of surgeons seeking to help and train locals in Tanzania at a Norwegian Lutheran hospital (which has been serving for more than 60 years). Some of the in As the mother of an EMT currently pursuing a Master's in Global Medicine Management, I picked up this book with interest. My daughter hopes to spend time in Africa this summer, as well as her sixth trip to Nicaragua for a church eyeglass ministry. I learned a lot and am thankful. Bartelme is a fine writer and does a splendid job telling the story of surgeons seeking to help and train locals in Tanzania at a Norwegian Lutheran hospital (which has been serving for more than 60 years). Some of the incidents are detailed, but the short chapters make this book easy to read at a pace that doesn't overwhelmed. Recommended for anyone interested in international medicine, medical missions and learning about the sacrifices so many make to help "the least of these." Updated July 15, 2017. I was just chatting with my daughter, who is sitting in the Kigali, Rwanda airport. I sent her with this book and she loved it, finishing it just now. Her quote: "As a global medicine student I really appreciated his work toward creating sustainable medicine without foreign doctors."

  14. 4 out of 5

    Jan

    In the poorly populated areas of Africa there is much needed, but nothing is needed more badly than medical knowledge and skilled surgeons, well except for clean water and sanitary facilities. The author followed one particular neurosurgeon as he worked hard to change things and teach others even as he himself learned more. His story is amazing and inspiring and should serve to teach those who live near cities everywhere to be thankful, If anyone needs another wake up call, try reading Nine Pint In the poorly populated areas of Africa there is much needed, but nothing is needed more badly than medical knowledge and skilled surgeons, well except for clean water and sanitary facilities. The author followed one particular neurosurgeon as he worked hard to change things and teach others even as he himself learned more. His story is amazing and inspiring and should serve to teach those who live near cities everywhere to be thankful, If anyone needs another wake up call, try reading Nine Pints. I originally won a copy in a LibraryThing Giveaway but only read it just now because it walked back home, seems that it wandered away and was read by several friends.

  15. 5 out of 5

    Deborah Perdew

    This book was incredible, such an inspiration to me. I am looking forward to when this book is made into a movie. Amazing writing and a story I will never forget, of human compassion and wisdom.

  16. 4 out of 5

    Katie

    Great story, really interesting!!!!

  17. 4 out of 5

    Perri

    Dr. Farmer and his book Mountains beyond Mountains is mentioned in this book and for me , that is a superior story. Dr. Ellegala and his ego detracted from the story, but after all , he is a neurosurgeon and I suppose that's to be expected. He has a wonderful vision, though, of training local doctors in underdeveloped countries instead of the current model of foreign, temporary visiting doctors which leads to dependency and patronization. My spell check says that's not a word but it should be.T Dr. Farmer and his book Mountains beyond Mountains is mentioned in this book and for me , that is a superior story. Dr. Ellegala and his ego detracted from the story, but after all , he is a neurosurgeon and I suppose that's to be expected. He has a wonderful vision, though, of training local doctors in underdeveloped countries instead of the current model of foreign, temporary visiting doctors which leads to dependency and patronization. My spell check says that's not a word but it should be.The act of patronizing a person or in this case a county leading to feelings of inferiority and inadequacy.

  18. 5 out of 5

    E S

    Inspiring !

  19. 5 out of 5

    Sharon

    This book is proof that people are making good things happen in the world. An American neurosurgeon, Dilan Ellegala, takes a sabbatical to Haydom, Tanzania and discovers not only a place that soothes his soul but a place where there are only 3 neurosurgeons for a population of 43 million. It's a place where doctors from foreign countries come and go on short visits to perform surgery and other necessary medical procedures to save lives, thus making the population dependent on foreign medical per This book is proof that people are making good things happen in the world. An American neurosurgeon, Dilan Ellegala, takes a sabbatical to Haydom, Tanzania and discovers not only a place that soothes his soul but a place where there are only 3 neurosurgeons for a population of 43 million. It's a place where doctors from foreign countries come and go on short visits to perform surgery and other necessary medical procedures to save lives, thus making the population dependent on foreign medical personnel. Dilan's idea to train surgeons in the country so that there are more resident surgeons is successful but slowly and painfully. The story of the region and the people, and of a surgeon's mind and conundrums, is fascinating. The author, Tony Bartelme, is a Pulitzer Prize finalist for articles he wrote which later became this book. I was surprised to find some familiar things in the book: Paul Farmer, who has written several books and had books written about him (Mountains Beyond Mountains by Tracy Kidder), worked with Dilan and crew to put into place a global push to train surgeons in their own countries; Paul Young, a neurosurgeon from St. Louis, who I know; I worked for his father at St. Louis University Health Sciences Center and am acquainted with some of his family; Young Paul Young, as we called him (his father is also Paul Young) also was instrumental in the global association to train surgeons; and the name Godwin which is a family name in my clan -- one of the young Tanzanian surgeons-in-training named his first child that. I don't see the name very often. Aside from the familiar (how often does a reader find that in a book?), this is a great story about great work, nonfiction. It's an amazing journey and shows how just one person with a vision can make a difference, not alone but by inspiring others and working hard. Dilan did all this. It reads more like a novel, lest you think it's dry reading. It certainly isn't that. I received this book from Library Thing early reviewers.

  20. 5 out of 5

    Ginka

    My husband and I read this book because we were contemplating whether or not to have my husbands back surgery done by Dr. Ellegala who this book is about. By reading this book we became aware of what a caring, compassionate physician he is. To quote the author, "A Surgeon in the village is the incredible account of one man's push to 'train forward' - to change our approach to aid and medical training before more lives are needlessly lost. His story is a testament to the transformational power of My husband and I read this book because we were contemplating whether or not to have my husbands back surgery done by Dr. Ellegala who this book is about. By reading this book we became aware of what a caring, compassionate physician he is. To quote the author, "A Surgeon in the village is the incredible account of one man's push to 'train forward' - to change our approach to aid and medical training before more lives are needlessly lost. His story is a testament to the transformational power of teaching and the ever-potential for change. As many as seventeen million people die every year because of shortage of surgeons, more than die from aids, malaria, and tuberculosis combined. Dilan Ellegala and other visionaries are boldly proposing ways of saving lives." Dr. Ellegala did perform my husbands surgery and he is painfree for the first time in 10 months. Powerful book. To read about the minimally invasive spinal surgery performed with ultrasonic tools and techniques that he performed on my husband go to his website at sonospinesurgery.com

  21. 5 out of 5

    T Zoner

    Very inspiring!

  22. 5 out of 5

    Naomi Youngstein

    Lovely and wonderful, inspiring book.

  23. 5 out of 5

    Jennifer Hawes

    This is a must-read for anyone considering mission work or other short-term trips to countries in need.

  24. 4 out of 5

    Jill

    Doctor Dilan Ellegala is tired and need of a change when he goes to a remote area in Tanzania in Africa to perform neurosurgery. Face with overwhelming need, he is forced to improvise and begins to train Mayegga, an assistant medical officer, do brain surgery. It helps that desperate patients will travel hours to chance surgery with an unlicensed doctor when their only other option is a certain painful death. Much of the book is about Ellegala’s efforts to develop a treatment and training plan th Doctor Dilan Ellegala is tired and need of a change when he goes to a remote area in Tanzania in Africa to perform neurosurgery. Face with overwhelming need, he is forced to improvise and begins to train Mayegga, an assistant medical officer, do brain surgery. It helps that desperate patients will travel hours to chance surgery with an unlicensed doctor when their only other option is a certain painful death. Much of the book is about Ellegala’s efforts to develop a treatment and training plan that will continue in his absence. Obstacles range from lack of funding, equipment, regulations, self-discipline, and contractual obligations. At times, Ellegala’s ego gets in the way. His unbalanced life and failure to follow through continues until he meets Carin Hoek, a missionary pediatrician. As their relationship develops, so does his ability to focus and gather support. The author does a good job describing the unorthodox methods, surgeries, and environment. He skims the surface of despair and illustrates how even basic medical care, could prevent death. Although there are some successes and lives saved, it is not a happy ever after tale. It is just one way, one surgeon, looked at a global problem and tried help. LibraryThing Early Reviewers Giveaway randomly chose me to receive this book free from the publisher. Although encouraged, I was under no obligation to write a review. The opinions I have expressed are my own.

  25. 5 out of 5

    Kathy

    Why wasn't this thought of sooner? Why was there a cap put on residencies & is it still there? Hopefully, this will make a major change in the health of all the people in the world. Why wasn't this thought of sooner? Why was there a cap put on residencies & is it still there? Hopefully, this will make a major change in the health of all the people in the world.

  26. 5 out of 5

    Mara

    This review has been hidden because it contains spoilers. To view it, click here. Dr. Bartelme's audacity to do only what he felt compelled to do is both shocking and, ultimately, admirable. As a person who greatly values rules, his choices, of course, made me deeply uncomfortable. The fact that everything turns out all right in the end is difficult to attribute--was it luck, or does the universe really protect those acting with such deep sense of purpose? Dr. Bartelme's audacity to do only what he felt compelled to do is both shocking and, ultimately, admirable. As a person who greatly values rules, his choices, of course, made me deeply uncomfortable. The fact that everything turns out all right in the end is difficult to attribute--was it luck, or does the universe really protect those acting with such deep sense of purpose?

  27. 4 out of 5

    Joe

    A really nice, feel- good book. A slight bit technical is a few spots. I had checked it out of the library; as the back had previously been broken, a library worker had written "broken spine" inside the cover. Quite ironic. A really nice, feel- good book. A slight bit technical is a few spots. I had checked it out of the library; as the back had previously been broken, a library worker had written "broken spine" inside the cover. Quite ironic.

  28. 4 out of 5

    Cindy

    It was not an easy read but it is an amazing story.

  29. 4 out of 5

    Sandy

    An amazing story. A fast and engaging read.

  30. 4 out of 5

    Liralen

    The basic premise of this book is simple: that while sending 'Global North' doctors into 'Global South' countries might help close (barely) treatment gaps in the short term, in the long term it leaves local residents reliant on the whims of wealthier people in wealthier nations. Bartelme follows an American neurosurgeon who sought to change the model by training a Tanzanian man to perform brain surgery, effectively having him skip med school and just learn the nuts and bolts. I admit to being les The basic premise of this book is simple: that while sending 'Global North' doctors into 'Global South' countries might help close (barely) treatment gaps in the short term, in the long term it leaves local residents reliant on the whims of wealthier people in wealthier nations. Bartelme follows an American neurosurgeon who sought to change the model by training a Tanzanian man to perform brain surgery, effectively having him skip med school and just learn the nuts and bolts. I admit to being less interested in that American doctor's story than I am in the rest of it—at the end of the day, Ellegala (said American) has a life and a job to return to in the States. I do find it rather striking that he actually only trained one man, who later trained somebody else...a cycle that perpetuated itself, at least for a while. I was markedly more interested in these Tanzanian men, who were taking much greater risks than Ellegala (who was basically protected by both his medical degree and his passport) and would ultimately have to be the ones to carry things on, but who got less page time. Still...it makes a lot of sense as a model, when you consider some of the statistics: Tanzania had just three practicing neurosurgeons. Three for an entire country of forty million people. And all three were in Dar es Salaam, the country's biggest city, five hundred miles away. (25) Practitioners with medical degrees were rare—Tanzania had one doctor per fifty thousand people, among the worst physician-patient ratios in the world. In the United States and Canada, the ratio was less than one per five hundred people, and the ratios were even lower in many parts of Europe. Even so, some of these wealthier countries considered themselves short of physicians. (26) It's sort of hard to argue with foreign doctors coming in, under those circumstances, and yet: A few critics called short-term missions a form of "slum tourism" and participants "vacationaries." Some pointed out how the expense of flying a team of doctors to Africa or South America for a week could fund a clinic's budget for half a year. (150) A sociologist in Honduras...began a unique study after Hurricane Mitch left tens of thousands of Hondurans homeless. To help the Hondurans rebuild, a North American charity sent about one million dollars directly to local home builders and spent an additional million dollars on twenty-six mission teams from Canada and five groups from the United States. It was a perfect opportunity to compare two humanitarian approaches. Ver Beek found that the local builders constructed about one thousand homes, while the mission teams built thirty-one, one house per team. Put another way, the local builders spent about two thousand dollars to build a house, while the missionary teams spent roughly thirty thousand dollars, fifteen times as much. (151) And again...yet. How much of it is a question of money and how much of it is a question of training? The Honduran example is fascinating but also an imperfect match, considering that there are presumably many, many more skilled builders in Honduras than neurosurgeons in Tanzania (the book also doesn't give any details on those homes themselves, only how much they cost). So believe you me, I'm not arguing against a change in model or a shift to training more local doctors rather than bringing in temporary outsiders, but it's going to take a hell of a lot more than one doctor training one replacement...and to that end I'm more interested in the people who live there, who stay, who are doing the day-to-day ground work and living with the ups and downs. Side note...this was perhaps the best anecdote of the book: Robert Liston was Britain's best surgeon in the mid-1800s and was known to do amputations in under a minute. "Time me gentlemen, time me," he said before operations. Once when amputating a patient's leg, he accidentally sliced off an assistant's finger, and while switching instruments, slashed a spectator. The patient and assistant later died from infections, and the spectator was said to have died of shock, the only operation known to have a three hundred percent mortality rate. (38–39)

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