interest from the developed world in assisting the developing world, including providing surgical services. Involvement in the early 19th century began with a religious focus through "mission trips" that commonly had evangelical motives. The mission trip concept has evolved beyond religious goals to include trips geared towards providing medical and surgical care in the developing world during periodic short trips by medical teams. The typical goals of such trips are to treat patients in need, decrease the local burden of disease through direct patient care and to build local capacity through education and training. In 2012, there were approximately 6000 such medical missions with approximately \$250 million raised for funding [@bib0015].

In recent years, a growing number of teams of well-intentioned international orthopaedic surgeons have volunteered their time andtreatment. We present a case performed in Tanzania that resulted in the development of an untreatable post-operative complication. This testimony highlights the urgent need for a different approach to providing surgical services in the developing world, but also emphasizes the need for open forums for discussion of international morbidity and mortality cases.

2. Presentation of case {#sec0010}
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SM is a woman who at age 31 resided in a small rural village on the outskirts of Nairobi, Kenya. She lived with her parents and her two younger brothers in a 20 ft × 20 ft dwelling. At the age of 5, she was afflicted with a condition that affected several of her major joints. She was diagnosed with rheumatoid arthritis. Her condition was not treated medically due to a lack of family resources as well