“A Surgeon in the Village” is the story of neurosurgeon Dilan Ellegala and his key role in a Norwegian-funded mission hospital in the hinterlands of Tanzania. The story neatly unfolds in three parts. The first traces Ellegala’s life from his birthplace in Kandy, Sri Lanka, through an almost natural trajectory to a medical career, which accelerated after his ever-supportive family emigrated to the United States. Ellegala eventually lands in Haydom hospital in Tanzania, where he discovers its austere conditions and unfamiliar cultural terrain. It is here that he meets and ultimately decides to train an assistant medical officer (AMO), Emmanuel Mayegga.
The second part puts Ellegala back in the U.S. where he struggles to balance his “day job” in an Oregon hospital with a persistent pull back to Tanzania. Ellegala soon cobbles together a non-governmental organization (NGO) of sorts in an effort to promote his “teach first” approach, which emphasizes the transfer of skills and knowledge as an alternative to the hand-out-driven paradigm of most global charities.
This story is compelling enough on its own, and author Tony Bartelme tells it very well. Embedded within it are two themes that thoughtfully converge upon the relationship between Ellegala and his Tanzanian counterparts in particular, and between the Western and developing worlds more generally.
First is global health. To get at this, Bartelme pauses occasionally to give the history of Western medicine and explain the basics of neuroscience. What this does is contrast the broader challenges of global health and the hard realities of practicing medicine in the African context. For instance, Bartelme notes that while Ellegala was at Haydom, there were a paltry three CT machines for all of Tanzania, and 70 surgeons for a population of 40 million.
The book’s second theme is anchored in what Teju Cole has elsewhere called the “White Savior Industrial Complex.” Here Ellegala confronts the tendency of Westerners to patronize Africans in order to provide an experience for themselves. For instance, he is driven to madness by foreign medical students sitting in the front row during Haydom’s staff meetings, treating Tanzanians like “the hired help.” Above all, Ellegala is dismayed by the cycles of dependency that seem to plague both large-scale development aid programs and short-term medical missions. Bartelme seems refreshingly aware that even thinking about such things amounts to a self-indulgent validation of privilege in and of itself.