In Kenya I witnessed a gruesome operation. Without anesthesia or sterilized instruments, a man took a razorblade and cut into the scalp of a woman’s shaven head. She was seated on the ground, surrounded by her family. The omobari omotwe peeled back her skin. Using a chisel he then scraped the exposed skull for several hours, until he was satisfied with his work. The flaps of skin on the skull were placed over the open wound, cow’s fat was used to wash away the blood, cloth was wrapped around her head, and her husband and father helped her to her feet and accompanied to her house a few yards away. The patient remained silent and stoic.

This was a trepanning, a surgery practiced in a small part of western Kenya, perhaps the last place in the world where the ancient surgery still takes place. No modern equipment, no sanitary conditions, no medical degrees in sight. The Kisii offer no theory to explain the underlying reasons why the procedure works. Someone complains of debilitating pains in the head and, when all else fails, the omobari omotwe is summoned.

Once I was in town with a European doctor, the chief of the district hospital, who pointed out a teenager on the street. He had come to the hospital seeking help with complaints about his head, she said. She sent him home, assessing his condition as hopeless. The doctor fully expected the boy to die shortly. His parents took him to see the traditional head surgeon. And there he was, several years later, presumably in full health, playing soccer with friends.