Five neurosurgeons for 30 million people.
This statistic prompted Dr. Michael Haglund, a Duke neurosurgeon, to travel to Uganda in 2006 to gain a better understanding of the country’s medical conditions. Haglund then started the Duke Global Health Placement of Life-changing Usable Surplus with the help of Dr. Victor Dzau, chancellor for health affairs and president and CEO of the Duke University Health System, and Dr. Michael Merson, director of the Duke Global Health Institute and interim vice president and vice provost for global strategy and programs. Instead of selling the University’s surplus medical equipment, GH PLUS allows Haglund to bring the equipment to Uganda, as well as disadvantaged areas in China, India and other parts of East Africa.
“The conditions were just really, really terrible,” Haglund said, referencing his 2006 trip. “I consider the surgeons at the national hospital to be heroes to work through those conditions.”
Haglund noted the poor conditions in Mulago Hospital in Kampala, including the lack of monitoring equipment for measuring oxygen in blood and only 1,500 beds with one ventilator. He added that surgeons did not use medical drills, but instead employed a method similar to the way American doctors cut through skulls in the 1930s.
“[Dzau and Merson] really jumped on board and turned me loose,” Haglund said. “Dzau didn’t have to make all the surplus equipment available. But he did, and it’s working.”
The difference between other equipment-sending initiatives and GH PLUS is that the latter is comprehensive, as it emphasizes teaching foreign doctors how to use and fix the equipment, said Jane Pleasants, assistant vice president for procurement and supply chain management for DUHS.
For the past three years, all of the equipment donated by Duke has remained functional, she added, noting that donated equipment typically sits in foreign hospitals unused or broken down.
A ‘ripple effect’
In his first University-sponsored trip to Uganda in 2007, Haglund brought a team of 33 people and $1.3 million worth of equipment. Haglund said the trip—which included shipping the nine tons of equipment by air for $70,000—was partially funded from seed money provided by DUHS and DGHI. He noted that he also raises money from corporate sponsors and Duke’s surgery and neurosurgery departments to fund his trips.
“At the time, all the doctors could do was put a piece of gauze on a patient’s brain, hoping it would stop bleeding,” Haglund said. “Our team brought the hospital to the 2000s.”
Haglund began a top-down approach with his training at Mulago Hospital in Kampala. He trained surgeons in neurosurgery, with the thought that if surgeons could perform complex procedures, they could also perform basic ones.
He added that he wanted to devise a sustainable way to train surgeons to work in Uganda.
“My initial idea was the problem that if you bring a Ugandan over to Duke to train them, they will just stay,” Haglund said. “The least desirable place in the U.S. was better than the most desirable in Uganda.”
Haglund and his team began a residency program in the Ugandan hospital with the hopes of training enough Ugandans to have 14 neurosurgeons in the country by 2020, he said.
“Ninety percent of Ugandans don’t have access to neurosurgeons,” Haglund said. “Most people have to drive 12 to 14 hours on terrible roads. We wanted to send two surgeons out every year, Noah’s ark-style.”
Haglund then repeated the program in Uganda’s neighbor Rwanda, which began what he called a “ripple effect” at Duke.
Although it is common for medical teams to visit East Africa, Duke’s effort to bring equipment as well as surgical teams is one of the only American universities to do so, Haglund said.
Beyond the medical field
Haglund’s work is one example of the many projects that DGHI and DUHS are involved with in East Africa. DGHI sponsors the Women’s Institute for Secondary Education and Research in Muhuru Bay, Kenya—a school run by Sherryl Broverman, associate professor of the practice in the biology department.
DUHS and DGHI’s largest initiative is in Moshi, Tanzania, said Cynthia Binanay, program director of the Hubert-Yeargan Center for Global Health. Duke has partnered with Kilimanjaro Christian Medical Centre in Moshi for 20 years conducting clinical research, primarily on HIV, Binanay said. DUHS also works in Kenya and is potentially adding programs in Ghana and Rwanda.
“[This work] is trying to fulfill Duke’s... mission of research, education and service in a variety of areas,” Binanay said.
Merson wrote in an email that Duke’s involvement in Africa is not limited to the medical work and research that is done in East Africa. He listed DukeEngage programs in the region, the Duke Divinity School’s African Great Lake Initiative and the cultural anthropology department’s six-week study abroad program in Ghana and Togo.
“Duke has [had] a long-term, multi-disciplinary presence in Africa for many years,” Merson said.
DUHS will continue its work in Africa, which has been particularly impressive, Dzau wrote in an email.
“I am very proud of the work that our physicians, nurses and students are doing in Africa,” Dzau said. “At Duke Medicine, our motto is ‘medicine that changes the world.’ Our people are doing just that.”
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