Experience gained during 2 1/2 years' work as chief government surgeon for Nyanza Province, Kenya, is outlined. The wide variety of surgical conditions encountered and the problems posed in dealing with these by a chronic shortage of essential drugs, instruments, hospital facilities, and fully qualified staff are emphasised. It is suggested that at present the solution must lie in wider instruction in surgical techniques for general duties officers and clinical officers together with energetic community health, family planning, and preventive medicine programmes.