Two weeks in, Mayegga touched the tip of his moistened surgical glove to a patient’s brain for the first time. A month later, he was performing surgeries. By three months, he was able to do them alone in the room. “In six months, he could do all basic cranial neurosurgery, remove tumors near the surface, put in shunts. He even started to teach a U.S. medical student,” Ellegala says.

As remarkable as that sounds, it’s not much of a surprise to Adam Kushner, an associate in the International Health department at the Johns Hopkins Bloomberg School of Public Health. He’s the founding director of Surgeons OverSeas, which focuses on bringing up the level of surgical care in developing countries. Although Kushner has never crossed paths with Ellegala, he’s seen similar tactics employed with success.

While working as a general surgeon in Malawi in the early 2000s, Kushner knew a clinical officer who’d been trained to treat hydrocephalus. Even with all of Kushner’s American education, that’s something he had never learned to do. And through a program in Ethiopia, Kushner has helped train clinical officers in essential surgeries, including C-sections and appendectomies.