•There is a large discrepancy between the supply and demand of surgical services in the developing world, especially for nations in Sub-Saharan Africa.•There has been longstanding and growing interest from the developed world in assisting the developing world, including providing surgical services.•This case demonstrates the ethical challenges that can be created from performing surgical procedures in the developing world without concomitant access to appropriate patient follow-up or resources for treating post-operative complications.•Consequently, there is a need for a new paradigm which provides a more sustainable solution with increased local capacity to treat complications associated with surgical procedures.•Until adequate infrastructure is developed, the informed consent process for surgery in this setting should include a frank discussion about not only potential surgical complications, but also the possibility that they may not be able to be managed appropriately given constrained local resources.•In the interim, a forum such as a written morbidity and mortality conference can help provide rich descriptions of the issues and problems that are encountered so as to increase awareness of them so that appropriate solutions can be identified.