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.

(For a medical description of the operation written a half-century ago see:

Does the trepanning work? Reports are that most patients do survive the ordeal. I interviewed a woman at her home who had survived four such procedures; I met a man who had undergone the surgery who was an officer in a local coffee cooperative.

Another indicator that the operation works is that the omobari omotwe doesn’t get paid unless the surgery is successful. Presumably the traditional surgeons don’t do this for fun. Both their reputations and their income depend upon doing it right.

What got me thinking about the Kisii trepanning was a recent poll that showed Congress ranked below cockroaches, root canal, head lice and colonoscopies.

About a dozen Congressional representatives met to come with ideas to refurbish their reputations. One of their proposals: don’t pay Congress if it cannot pass a budget.

The omobari omotwe know you if you don’t deliver, you don’t get paid. It is really a simple idea. You don’t need a head operation to to understand that. Or maybe you do.

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