In the Loupes: Surgery in Africa

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By Tomas Martin, M.D.
Professor of surgery

When you think of Africa, you probably think of jungles, lions, monkeys, gazelles, elephants and wide-open savannahs.

What you probably don’t think about is the need for surgeons. According to a 2011 article in the World Journal of Surgery:

“The critical shortage of surgeons and access to surgical care in Africa is increasingly being recognized as a global health crisis. Across Africa, there is only one surgeon for every 250,000 people and only one for every 2.5 million of those living in rural areas. Surgical diseases are responsible for approximately 11.2% of the total global burden of disease. Even as the importance of treating surgical disease is being recognized, surgeons in sub-Saharan Africa are leaving rural areas and their countries altogether to practice in more desirable locations. The need remains greatest in rural areas. Africa’s population has surpassed one billion and a significant majority, 60–65%, lives in rural areas.” [1]

Most surgical problems in Africa are not complicated. For us in the US, they are routine, treatable conditions. The top four are trauma, obstetrical complications and emergencies, acute abdomen conditions (from all types of causes) and finally, routine problems, such as hernias.  In the pediatric population, common surgical problems abound and are responsible for 6 to 12 percent of all pediatric admissions throughout sub-Saharan Africa. Top this off with more than 500,000 women dying each year because of pregnancy complications, most of which are salvageable with appropriate surgical backup. This number almost pales to the potentially preventable 1 – 2 million trauma deaths per year. All in all, in Africa, the mortality from possibly salvageable surgical problems exceeds the yearly mortality from AIDS.

My journey to Africa, however, didn’t begin with knowing these statistics. Approximately six years ago I felt a real need, a calling you might say, to do short-term medical missions. Being the outdoorsman that I am and having read about Africa all my life, I was immediately drawn to the possibility of going to Africa. My initial attempts to visit Africa did not come to fruition and I ended up going to the Dominican Republic, then the Philippines and then Haiti.

In 2010, I met Dr. David Thompson, a missionary surgeon who has dedicated his life to building a hospital complex in the African country of Gabon and founding a group called the Pan-African Academy of Christian Surgeons. In early 2011, with his invitation and through an organization called World Medical Mission, a subdivision of Samaritan’s Purse, I traveled to Bongolo Hospital in Gabon. Then in 2012, World Medical Mission arranged for me to go to Baptist Medical Center (BMC) in Nalerigu, Ghana.

Both hospitals are similar in that they are completely faith-based organizations, one run by the Christian & Missionary Alliance of Gabon and the other by International Mission Board. Both complexes are in very rural areas and serve large, very underserved, poverty-stricken populations. They are both “good-to-excellent” hospitals for rural Africa, but you have to remember, “TIA:” This is Africa.

For starters, Bongolo had oxygen available (most of the time); BMC did not. Neither place had any consistent labs, other than hematocrit and malaria tests. Both had moderate quality ultrasound machines that you had to know how to use yourself, and plain X-rays if you could find the X-ray tech, but forget about anything else. Almost everything was reusable, including scrub brushes, sponges, suction tubing and other essential supplies. In both places, it didn’t matter what operation you performed, the only pain meds available were Tylenol or ibuprofen.

Both hospitals had open wards (even a 16-bed so-called “isolation” ward at BMC, which should be a closed area for patients with infectious diseases). It was filled mostly with patients suffering from necrotizing fasciitis, a severe, flesh-eating bacterial skin infection. The hospitals’ beds were, at best, circa 1960’s. In Gabon, they were built high enough to allow a family member to sleep underneath. Neither institution had food for the patients or linens for the beds. They did have cook houses (open, concrete-floored, pole-barn looking structures) where families cooked over open wood or charcoal fires. Open areas with water for families to wash were also available. So, needless to say, it was somewhat of a culture shock for me. But, I quickly adapted.

It was quite humbling to me, an accomplished cardiac surgeon, going back to treating diseases I haven’t treated in 20 years and doing operations that I had long forgotten. I even did a C–section, which I had never previously done. Thankfully, the people there were experienced enough and kind enough to coach me along and make me feel useful. As for the patients, they were so grateful for whatever you did and never questioned your judgment or your treatment.

Several things really stuck with me. One is how spoiled, yet blessed, we are here. Another is how much you can get done and the good you can do there with so little, by our standards.  I also was impressed again by the real reason I, and most of us, went into the health care field — the need to help people in whatever manner I can. The long-term medical missionaries I came in contact with are my heroes. They were not only great health care providers, but also true servants in every regard. I can only hope that if I learned anything in Africa, it is how to be a better servant.


[1] J.D. Pollock, et al., Is it possible to train surgeons for rural Africa? A report of a successful international program. World J. Surg. 2011;35(3) 493-499. Accessed 5/15/13.     

 “In the Loupes” is an online column meant to give readers insight into what it is like to be a surgeon today. Faculty members and residents from the University of Florida College of Medicine’s department of surgery write the columns based on their experiences in academic surgery. Views expressed here are not necessarily those of the department of surgery, the College of Medicine or the University of Florida.