Non-medically qualified practitioners of medicine are not new. One may look at two spectacular examples of the contribution by these colleagues, Hamilton Naki and Mamitu Gashe.

In the 1960s, Naki was part of the transplant team at South Africa’s Groote Schuur Hospital in Cape Town. He worked with Christiaan Barnard, who performed the first human heart transplantation. Naki was a gardener in the grounds of Groote Schuur, who was enlisted by the transplant team to help with experimental transplant work involving animals. In this role he not only prepared animals for organ donation and transplants but also assisted with operations on animals. In the process he learned anatomy and surgical techniques.

Rosemary Hickman, a transplant surgeon at the hospital, said of Naki, ‘Despite his limited conventional education, he had an amazing ability to learn anatomical names and recognize anomalies.’ Head of the Liver Research Centre at the University of Cape Town Ralph Kirsch said, ‘He was one of those remarkable men who really come around once in a long time. As a man without any education, he mastered surgical techniques at the highest level and passed them on to young doctors.’ Barnard described Naki as ‘a better surgeon than I am’.1,2

The life and work of Gashe was no less illustrious and particularly humane. In 1962, Gashe nearly died in childbirth at the age of 16 and suffered an obstetric fistula, or vesico-vagina (V-V) fistula. V-V fistulae are common in Africa and are a source of humiliation for women, often leading to isolation from society.

The Australian surgeon Catherine Hamlin and her husband Reginald Hamlin dedicated their lives to the management of V-V fistula in Africa, with an ambition to eradicate the condition. They helped found the Addis Ababa Fistula …