For Paul Kanulambi Walelu, dealing with gunshot wounds, open fractures, emergency caesarean sections, peritonitis, and typhoid perforations is all in a day’s work. Or, quite often, all in a night’s work. For as well as working seven days a week, Mr Walelu, an anaesthetic nurse, works every other night, for the medical aid organisation Médecins Sans Frontières at the busy Rutshuru Hospital in North Kivu, the war-torn province on the eastern border of the Democratic Republic of Congo.

It is Mr Walelu who in October last year helped the British surgeon David Nott in a forequarter amputation on a 16 year old boy who was close to death (BMJ 2008;337:a2958, 10 Dec, doi:10.1136/bmj.a2958). The boy had previously had an operation to remove the upper part of his arm, but his stump was septic and gangrenous when Dr Nott arrived for a month’s voluntary service at the hospital. …