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When Duke neurosurgeon Michael Haglund, M.D., Ph.D., visited New Mulago Hospital in Kampala, Uganda, last January, he was astounded at what he saw.

"This national hospital has 1,500 beds and only one ventilator," he says. "When they anesthetize patients, they have to handbag -- have people squeezing a bag of oxygen to help a person breathe. They don't have plates to hold the skull flaps in place, so people who have had brain surgery often have grotesque swelling of their heads because the sutures aren't strong enough to hold the skull flap in place. In the orthopaedic operating room, they still use ether to anesthetize people. By mid-afternoon, they have to stop surgery because the nurses and doctors are beginning to faint from the ether fumes. They do brain surgery with technology that was used at Duke in the 30s and 40s."

All this will change in August.

That's when Haglund will travel to Uganda with a neurosurgical OR team and equipment and donations worth more than $1 million to revitalize neurosurgery in Kampala. This Ugandan neurosurgery project was made possible by the passion of Haglund and others, support from the Department of Surgery, Division of Neurosurgery, the Duke Global Health Institute, private donors, and a new surplus program at Duke.

When Small Plans Get Bigger

The story began with the visit of Ugandan pastor Jackson Senyonga to Haglund's church in 2006. "For 10 years I have taken service trips down to Ecuador," says Haglund. "But Pastor Jackson's visit inspired me to consider a surgical mission to Uganda."

Originally, Haglund wasn't thinking big. Maybe he could take a ventilator or two, a few drills. Enough to help out. But when he asked around the hospital to see who might go with him, he was overwhelmed by the response. "Within 48 hours, I had 18 people volunteering to go," he says, still shaking his head in wonder. "God had bigger plans than I did."

Haglund shared his ideas with Michael Merson, M.D., director of the Duke Global Health Institute. Haglund's passion inspired Merson to approach Chancellor for Health Affairs Victor J. Dzau, M.D., to propose a new program that could make it easier for faculty such as Haglund to take surplus medical equipment and supplies to developing countries. And thus was born Duke Global Health PLUS (Placement of Life-changing Usable Surplus).

Providing Usable Surplus to Developing Countries

The Global Health PLUS (GH PLUS) program is a new program housed in the Duke Global Health Institute. It is part of a larger surplus program of Duke University and Duke Medicine organized through Duke University Procurement.

"This is part of a visionary effort by Duke to address the needs of underresourced communities that are unable to provide adequate surgical or intensive care services," Dzau says. "The project in Uganda this summer is a terrific example of the difference that can be made through this effort of the Duke Global Health institute."

Working with GH PLUS, Haglund began to collect surplus materials earlier this year.

"A health system like Duke produces a lot of surplus equipment and supplies," says Jane Pleasants, assistant vice president for Procurement Services. "Equipment is replaced by newer equipment or retired because a unit or office is moving. And there are medical supplies and materials that have been prepared for but not actually used in surgical or other medical care. For various legal, regulatory and logistical reasons, many of these usable materials cannot be redistributed at Duke or in the local community."

But they can change lives in developing countries.

"I was often aware of what was being replaced in the [Duke University Hospital] OR," says Haglund. "But through GH PLUS, I found out about defibrillators coming from Durham Regional Hospital, critical care monitors coming from Duke Raleigh Hospital, and more."

By early July, Haglund had three rooms stuffed with equipment: 14 ventilators, eight anesthesia monitors, two operating microscopes, 1,000 plating systems for bone flaps, ten oxygen saturation monitors, seven automatic blood pressure monitors, 31 transport heart monitors from the ER -- the list goes on. He also had a team capable of setting up and staffing a neurosurgery OR and recovery room.

Making a Long-Term Difference

The team will travel to Uganda in August for 12 days. They will set up all the new equipment and spend a week completing 40-50 brain and spine surgeries.

What really excites Haglund, however, are the longer-term implications.

"It is not often you get the opportunity to change how an entire country practices medicine," he says. "With the gift of this material and training, we can and will change how neurosurgery is practiced in East Africa."

"When we leave Uganda , there will be a modern OR there. But part of the mission of GH PLUS is to ensure that when Duke sends equipment to third world countries, we also ensure that the people there know how to operate and maintain it," says Haglund.

That's why Haglund obtained an educational grants from Synthes Spine and the Integra Foundation to pay for a Ugandan clinical engineer to receive eight weeks of training in maintenance of surgical equipment over the course of a year in Ghana -- the closest place where training is offered.

In addition, the Foundation for International Education in Neurosurgery is setting up a site to train neurosurgeons in East Africa. " Uganda was not going to be able to participate because of lack of equipment," says Haglund. "Now they can."

Haglund will serve as co-director for the new neurosurgical training program in Kampala.

"We at Duke not only want patients in our local community to receive the best care, but also those living in underserved areas throughout the world," says Merson. "GH PLUS gives us the opportunity to do this while at the same time expanding Duke's growing international presence."