How to Start WALANT Practice in South Africa: “Service With a Smile if You Are Willing to Wait Awhile.”

Wide-awake local anesthesia no tourniquet (WALANT) hand surgery at 1 Military Hospital in South Africa resulted in a positive patient experience and beneficial financial outcomes in an economically constrained environment. Using the WALANT technique also effectively reduced the waiting time for elective surgery, which is considered to be synonymous with improvement in the public health sector in South Africa. Elderly patients and those medically unfit for general anesthesia successfully underwent WALANT surgery and returned to daily activities. Additionally, the South African WALANT surgery initiative established a successful outreach program with Operation Healing Hands. Continuation of WALANT procedures during the pandemic in a “do not touch” environment had a low probability for disease transmission and was advantageous in reducing the elective surgery workload. In the beginning, WALANT’s initiation at the institution was brutal. Eventually, the critics shifted to value the inexpensive, effective service delivery of the WALANT method. Flexibility, open mindedness, and resilience are necessary to implement wide-awake surgery initiatives successfully.