The spectrum of surgical practice is a reflection of the disease pattern. The 3-tier stratification of the health care delivery system in Nigeria (primary, secondary, and tertiary care) corresponds to the level of surgical sophistication available at different levels. Gastroenterologic, urologic, orthopedic, cardiothoracic, oncologic, plastic and reconstructive, otorhinolaryngologic, endocrine, and vascular surgery are almost exclusively performed at tertiary health care centers, while primary health care surgery is limited to emergency first-aid care of minor trauma, suturing lacerations, splinting fractures, and incising and draining abscesses. The surgery often done is the surgery of trauma, infections, and neglect.15 The largest group of surgical cases is found at the secondary level of health care. In a 14-year review of a secondary level surgical practice, external hernia repair constituted 56.1% of the procedures undertaken, excision of superficial lumps about 11.5%, and abdominal emergencies, such as intestinal obstruction, peritonitis, and ruptured spleen, about 7.7% (Table 2).16 The broad-based training necessary for service in rural areas and those areas understaffed by physicians includes skills in cesarean sections, vesicovaginal fistula, and other gynecologic procedures. Surgery for tropical conditions, such as elephantiasis, chronic granulomatous diseases, ameboma, and African histoplasmosis, typically accounts for only 12% of operations.17 Some of these conditions, though common in the tropics, are also seen in other parts of the world. What is characteristic of Nigeria is that patients with advanced disease tend to seek care in an environment where there are limited resources to cope with them.