DAR ES SALAAM, TANZANIA

by Dlantha Ellegala, MD, FIENS Volunteer, 2007

Somewhere tucked away in the hidden villages of rural Tanzania, Haliba was born seven years ago. Her atrophied legs were unable to support the scant weight of her thin skeletal frame. She came to the hospital wrapped in a cloth and tied to her mother’s back, the way most children half her age tend to arrive. Having been carried this way for seven years gave Haliba the chance to watch her world go by and perfect her infectious wide-mouthed smile. And it gave her world the chance to see what was the most identifying feature of this beautiful little girl: a head several sizes too big for what had become a seemingly shrinking body.

It took several months after she was born for her parents to notice that their first child had something a bit frightening and different about her. Concerned, they sought out the best help they could find, but given their limited resources and the scarcity of options the best they could do was watch and wait. Without the ability to leave their fields or the funds to travel at least two days to Dar es Salaam to have a shunt placed, the best they could offer to their daughter was an overly cautious childhood and the hope that someday a better option would present itself before it was too late. Then one day, it did.

While in Tanzania in 2005, Dr. Dilantha Ellegala happened upon a 400-bed hospital in Haydom that had a catchment of 1.3 million Tanzanians and struggled under the burden of neurosurgical emergencies without a neurosurgeon. Within six months Dr. Ellegala taught Emmanuel Mayegga, a Tanzanian assistant medical officer previously trained in general surgery and the most senior ranking surgical staff available, to independently perform burr hole evacuations, craniotomies, shunt placements, and provide consistent, community-based, neurosurgical care in a part of the world previously thought too remote for such specialized procedures.

Two years after learning the procedure, it was Mayegga’s hands that placed the shunt in Haliba’s head to relieve her hydrocephalus, teaching others as he performed the procedure. Mayegga has now transitioned into the role of a trainer. The neurosurgeons at Muhambili University and the Tanzanian Ministry of Health are developing independent, self-sustaining neurosurgical care in full accordance with the Neurosurgical Training Program – East Africa. This will provide a sustainable solution to problems once seen as unsolvable not only to ministries of health and neurosurgeons, but to patients like Haliba.