KAMPALA, Uganda – The American neurosurgeon leaned in to take a selfie with his female patient, chuckling with excitement when she raised her hands.
That was a good sign the day after Dr. Michael Haglund and his Duke University team opened the patient’s skull to remove a tumor.
The operation was one of many complex, life-saving surgeries the team performed in mid-August on Ugandan patients who otherwise had little hope of survival. The surgeries, which would cost up to $20,000 in the United States, were free while a group of American doctors took part in a “surgery camp” during which they also train local doctors.
Scores of hopeful patients crowded the hallways of Mulago National Referral Hospital in Kampala, the Ugandan capital. The demand forced Haglund to perform triage, what he frankly called “death rounds.” Although many people were turned away, at least 22 were operated on, including some who still “were probably going to die,” he said.
Public health service in Uganda long has been poor because of limited government funding. Although private hospitals are springing up, most people cannot afford their services in a country where many live on less than $1 a day.
Many qualified-but-underpaid Ugandan health workers also have sought opportunities in Europe and the United States. The highly specialized field of neurosurgery is one of the hardest hit, with only six qualified neurosurgeons working in the East African country of 36 million people.
Uganda’s main referral hospital, Mulago, presents a picture of decay and neglect. The floors just outside the operating theaters are smeared with dried blood, and the paint is peeling off the walls. The elevators fail at times, stranding nurses moving patients from operating rooms to the intensive care unit.
Vil Kengoma, 21, the university student with whom Haglund took the selfie, had a likely fatal brain tumor that left her in severe pain and paralyzed in her right hand. In the crowded ward where she rested after surgery to remove it, she looked dazed but smiled at Haglund as he asked her to raise her hands.
“She had been admitted for three weeks, and she went straight from the intensive care unit to the surgery room,” her sister, Janet Karungi, said. “We are so grateful.”
Haglund, a professor of surgery and neurobiology at Duke, said he was shocked by what he saw in 2007 when he first visited Mulago. There were 1,500 beds but just one ventilator for the operating theatres.
“The patients who were having brain surgery, they were getting into their brains with something like a hand drill,” he said. “Very crude ... like 1930s U.S. style.”
Haglund decided to improve Mulago’s neurosurgery capacity, which has required fundraising and spending his own money. His plan was to bring a surgical team of 20 to 40 people, including biomedical engineers and anesthetists, who would join local surgeons to operate on dozens of patients each year.
Haglund’s team has come to Mulago nine times since then, bringing 45 tons of donated or used equipment worth $6.5 million. The machines have transformed what used to be a tea room inside Mulago’s main operating theater into a modern operating room – used primarily for neurosurgery – that is now named for Haglund.
Haglund said Ugandan neurosurgeons are growing more confident treating complicated cases and that he hopes Mulago over time can build a reputation for safe brain surgeries.
One indicator of progress is the rise in number of cases the Ugandans handle each year, from 65 in 2007 to more than 500 last year.