Some papers send more than just one message. And sometimes, the number of messages is unintentional or at least not explicitly debated in the article. Such papers have been produced before, but perhaps we should elaborate on these imbedded signals.

The primary messages brought forward by this paper include:

1. Non-doctors, if properly trained, but lacking pathophysiological insight, can provide acceptable surgical care and raise the standard of health care;

2. Training in science can be and should be dovetailed into capacity building as an integral part of quality control;

3. Scientific work can be performed outside the laboratory and the established, high-tech hospitals. Science/evidence can be produced where everyday activities occur; and

4. Large Level-1 Trauma Centers probably are cost-ineffective in most low-resource regions as they consume too many resources and most people do not have access to them.