- Monday, April 9, 2018

Dilan Ellegala’s journey to become a neurosurgeon began when he was four years old. “He came up to us and said, ‘I want to become a doctor,’” his mother, Chitra, recalled.

At the time, he and his family lived in Kandy, a city in a mountainous region of Sri Lanka in Southeast Asia. But his parents, both teachers, had grown concerned about the island nation’s education system. “We didn’t think he would become a doctor if we stayed,” Chitra said.

So, in 1974, the Ellegalas said goodbye to friends and other family members and moved to the United States. They ended up in Brookings, South Dakota, where Dilan’s father, Somisara, had visited in 1956 with a Fulbright exchange program. Dilan’s father, now deceased, often spoke about how he came to America with $20 stuffed in his sock.

The Ellegalas arrived in the middle of a South Dakota winter, but his father’s old friends in Brookings greeted them with closets full of sweaters and jackets.

They lived above a restaurant called The Pizza King, with Dilan and his two sisters sharing the apartment’s lone bedroom. His father was the pizza parlor’s manager; his mother did the restaurant’s books. “My parents worked hard,” Dr. Ellegala said. “And this made me even more determined to become a doctor — to honor their sacrifice.”

Dr. Ellegala never wavered from his goal, excelling in college and entering medical school at the University of Washington in Seattle. There, he fell in love with the brain. “Here it was, everything a person was or hoped to be — the very expression of possibility.” He sometimes took specimens home from the lab to study its structures. “The brain is so beautiful.” He stored the specimens in a mini-fridge, much to his roommate’s dismay.

He did his neurosurgery residency at the University of Virginia, one of the toughest programs in the country. He spent night after night in the operating room. One year he did more than 650 procedures. “Experience and pressure — that’s the only way you master the skills to safely operate on something as delicate as the living human brain,” he said.

After seven years of residency, Harvard Medical School awarded him with a fellowship to learn cerebrovascular procedures. These are among the riskiest and most challenging brain surgeries. Surgeons insert clips the size of mosquito wings on blood vessels deep inside patients’ brains, a way of disarming aneurysms, the time bombs that cause strokes.

But this long educational marathon left him exhausted. He promised himself a six-month break after the fellowship. And, in 2006, he set off for Tanzania to recharge. He traveled to a remote missionary hospital on the edge of the Great Rift Valley, hours from the nearest paved road. He would do a surgery to keep his skills sharp. “But I decided I’d spend most of the time exploring the bush.”

That plan shifted when he was confronted with one of the world’s most neglected health problems: the shortage of surgeons. An estimated 5 billion people across the globe lack access to safe and affordable surgery, and as many as 17 million people a year die because of this deficit. At the time, Tanzania had only three neurosurgeons for its entire population of 42 million people. “It’s a huge global health problem that few people are talking about,” he said.

Charities and universities sponsored short-term medical missions to help bridge this gap. But despite the good intentions of many who went on these trips, this humanitarian model simply wasn’t getting the job done, he said. And, in some ways, it made things worse.

“Traditional medical missions usually involve doctors who fly in and treat as many patients as they can and then leave,” he said. “But it creates a form of dependency. It sends a message to locals that they can’t take care of their own people.”

So, during that first trip, he decided to teach basic brain surgery to a Tanzanian clinician named Emmanuel Mayegga.

Mayegga wasn’t a fully certified doctor but was a quick study. And with Dr. Ellegala by his side, Mayegga saved one patient after another.

But Dr. Ellegala wasn’t content to stop there. He decided to teach Mayegga how to teach others. Mayegga then taught a second Tanzanian, who taught a third.

Based on this success, Dr. Ellegala formed a nonprofit called Madaktari Africa to promote this teach-first approach. He and others with the group have worked closely with the Tanzanian government, including its former president, Jakaya Kikwete. Through Madaktari (Swahili for doctors) Africa, more than 500 health care professionals have traveled to Tanzania to teach neurosurgery, heart surgery and other medical procedures.

“The old model of sending doctors on medical missions to treat people just doesn’t work,” he says. “You should always teach first.”

Dr. Ellegala’s global health work was documented in the new book, “A Surgeon in the Village: An American doctor teaches brain surgery in Africa.” Written by Tony Bartelme, the book also describes how Dr. Ellegala met Carin, a Dutch pediatrician who also worked in Tanzania — and how they were married on a grass airstrip in front of thousands of cheering villagers.

Today, Dr. Ellegala sees his “teach first” efforts in low-income countries as a new goal, one that harmonizes with his pioneering work with ultrasound technology in the United States. As SonoSpine’s technology takes off, he hopes it will help fund new teach-first programs.

“There’s a great African proverb: ‘If you want to go fast, go alone. But if you want to go far, go together.’ That’s what we need to do — work together, transfer skills, innovate. If we do that together, anything is possible.”

For more information about “A Surgeon in the Village: An American doctor teaches brain surgery in Africa” (Beacon Press, 2017) by Tony Bartelme, please visit https://tinyurl.com/y9v95yxx

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