The Jefferson Debating Society concluded its Spring 2015 Distinguished Speaker Series Friday afternoon with a presentation from Dr. Dilan Ellegala — a neurosurgeon and founder of the Madaktari Africa Project called “Brain Surgery in the Bush.”
Ellegala completed his residency in neurosurgery at the University Medical Center, under the supervision of Dr. John Jane, who was chair of the neurosurgery department from 1969 until 2006.
According to Ellegala, Jane completely altered the way neurosurgery residencies were done. He said that for the first few years, residents would just follow their mentors around, assist them for the next few years and operate on a few cases in their last year or two.
“He came in from day one and everyone of his trainees operated from the very first day they started training,” Ellegala said. “They were given amazing amounts of responsibility — more than what was imagined before.”
When Ellegala found himself in a remote Tanzanian hospital, he adopted a similarly revolutionary strategy.
After completing his eight-year residency and a year-long fellowship, Ellegala decided he needed a vacation. He said that all but one of his mentors from those years called him to tell him that he was crazy, and that he was ruining his academic career by not starting work right away.
“There was only one person who called me, Dr. Jane, who thought this was a good idea,” Ellegala said. “He called me and said, ‘Dilan, I hear you’re going away.’ I said yes. He said, ‘Good. It will make you more interesting.’”
Rather than relaxing the whole time, as he had initially planned, Ellegala started working at Haydom Hospital in the northern-central part of Tanzania. Haydom was started in the 1950s by a Norwegian family as a missionary hospital.
Ellegala said that while medical missions may benefit the specific patients they treat, in the long run they can actually damage a region’s health system by creating a system of dependency.
“Haydom Hospital served a population of about 2 million people spread out throughout north Tanzania,” Ellegala said. “It had 400 beds and at any one time 650 patients, and no Tanzanian doctors.”
Ellegala described the scene with which most mornings at the hospital started. During radiation rounds, the visiting doctors would sit around discussing radiographs while the local healthcare workers and medical officers stood in the back.
“They were disenfranchised from the care of their own people,” Ellegala said.
One night, Ellegala sat down with one of the local healthcare workers, a medical officer whom he called Dr. Mayegga out of respect. They went over the next day’s CAT scans, and Ellegala told Mayegga which questions he would ask and what the answers would be.
“So the next day, we looked at the same CAT scans, I asked him the same questions, he answered the same answers, and all of a sudden, everybody in the room looked at him with newfound awe,” Ellegala said.
From there, Ellegala began training Mayegga to actually perform neurosurgeries. He says he performed surgery with Hydeki assisting, assisted surgeries Mayegga performing and then watched while Mayegga performed surgeries with the assistance of other local healthcare workers.
A short time later, a Tanzanian doctor who had gone to medical school in the U.S., completed his residency in neurosurgery under Mayegga at Haydom Hospital. Haydom now has what Ellegala calls three “generations” of local healthcare workers.
Dr. Carin Ellegala, a pediatrician and Ellagala’s wife, was on hand during the presentation, also answering questions.
Carin Ellegala was running the pediatrics ward at Haydom, where she was the only actual pediatrician, when she met Dilan.
“I went over to the neurosurgery ward to see what Dilan was doing differently, and he was an arrogant man,” Carin said. “I had my sleeves rolled up, literally, but he had his hands behind his back.”
Ellagala attributed this strategy to his time spent under Jane.
“He forced you to figure things out for yourself, and that moment, where I kept on going, and it worked, you can’t get that in your notes,” Ellegala said. “Surgeons who finish this program are better neurosurgeons.”
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