Duke’s Medical Surplus Finds New Life in Uganda

Months of rummaging in basements, diving in Dumpsters, and pleading for castoffs paid off for a Duke University neurosurgeon and his team of 27 colleagues who flew to Uganda last month to deliver more than $1-million worth of surplus medical equipment to an impoverished hospital in the capital city of Kampala.

While they were there, the team performed 30 brain and spinal surgeries and taught local engineers and doctors how to use and maintain the high-tech equipment.

Michael M. Haglund, an associate professor of neurosurgery and neurobiology, says the high point was removing a spinal tumor from a 12-year-old girl who was only able to move her toes before the surgery, but who will now walk again.

“It was rewarding and amazing and just the beginning of a much larger vision we have for Uganda,” says Dr. Haglund, who plans to return at least twice next year.

He thought up the trip last year after hearing an impassioned appeal from a Ugandan pastor who was visiting his church. Dr. Haglund visited Kampala’s New Mulago Hospital in January and was appalled at how sparse and primitive its medical equipment was.

The 1,500-bed facility has only one ventilator to help patients breathe, and doctors rely on hand drills to cut through patients’ skulls during surgery, he says. The entire country of 28 million people has only six neurosurgeons.

“One of the nurses there said, ‘If you could bring one oxygen-saturation monitor, it will be a miracle,'” Dr. Haglund says. “I told her, ‘I promise, if I have to put it in my suitcase, I will.'”

When he returned to Duke University Medical Center, Dr. Haglund learned that like other major research universities, Duke was bursting with outdated but still useful equipment that was jammed into three warehouses and 30 to 40 semitrailer trucks.

Salvage From Storage

He began quizzing his colleagues about when their ventilators and microscopes would be replaced, and spent hours scrounging through storerooms for usable equipment. After getting permission from the university to pursue his project, he became a familiar sight at its surplus store, where he snagged equipment on its way to storage or before liquidators arrived to haul it off.

“It was like being on an Easter-egg hunt in this big warehouse,” Dr. Haglund recalls. “Everything was covered in dust, but when you brushed it off, it worked fine.”

Before long, he had amassed an impressive collection of microscopes, anesthesia machines, ventilators, vital-signs monitors, and other devices. The nine tons of equipment donated from Duke and private donors that have already been sent to Uganda are worth about $1.3-million, which represents a quarter of the Kampala hospital’s annual budget.

Dr. Haglund, who talks with his colleagues about his faith and plays Christian music in the operating room, says he hasn’t had much success in the past recruiting volunteers for his mission trips, but this one was different. “In two days, 18 people said they wanted to go with me,” he says.

The group, which grew to 28, included neurosurgeons, nurses, anesthesiologists, and technicians. After setting up five high-tech operating rooms and an eight-bed intensive-care ward, the group operated from dawn until dusk for five days.

The team included a couple of Duke engineers who taught local engineers how to maintain the equipment, and Dr. Haglund also received grants to allow a Ugandan engineer to receive eight weeks of specialized training. “We don’t want to take over a 400-pound anesthesia machine and have it become a giant boat anchor,” he says.

An Economical Move

His biggest score, Dr. Haglund says, was 31 monitors he intercepted on their way to storage when he learned that Duke’s emergency room was shifting to a new system. “I have to admit I was breaking one of the commandments by coveting those monitors,” he says.

The machines cost $20,000 each new, says Dr. Haglund, and the university would have only gotten a fraction of that if it had sold them.

The idea of giving away surplus equipment also made sense to Jane Pleasants, assistant vice president for procurement and supply-chain management for the university and its health system. She says the university probably was spending $1.5-million a year just moving equipment into storage and to the surplus store, and another $600,000 holding it in temporary storage.

“We began exploring the business case and discovered that it would be much less expensive to give it away,” she says.

That might not be immediately apparent to department chairmen, who are accustomed to getting consignment fees for their old desks and bookcases, she says. But 700 recent transactions were for less than $100 — hardly worth the paperwork and moving costs involved, she concluded.

Taking rent, labor, and moving costs into consideration, she says, the university was, in fact, subsidizing the surplus store to the tune of $250,000 a year: “We said, Nobody is getting a lot of money here, and we’re not building good will.” The surplus store shut down in July, and the new surplus-donation program began. Now, when departments are unloading equipment, rather than sending it into storage, a mover takes it directly to a moving company storeroom, where 15 charities stop by weekly to haul off what they want.

Meanwhile, the Duke Global Health Institute has started its own program for sending surplus equipment and supplies to developing countries.

“We’re just trying to make a difference,” says Dr. Haglund, who, along with other team members, chronicled their journey on a blog. “It’s rare that you get an opportunity to change the way a hospital, let alone a country, practices medicine.”

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