World Journal of Surgery

, Volume 35, Issue 6, pp 1175–1182 | Cite as

Surgical Capacity Building in Uganda Through Twinning, Technology, and Training Camps

  • Michael M. HaglundEmail author
  • Joel Kiryabwire
  • Stephen Parker
  • Ali Zomorodi
  • David MacLeod
  • Rebecca Schroeder
  • Michael Muhumuza
  • Michael Merson



Neurosurgical capacity is extremely deficient in East African countries where 27 neurosurgeons serve more than 250 million people. To build capacity, the Duke University Medical Center and New Mulago Hospital in Uganda applied a two-pronged twinning approach that placed usable surplus equipment in a developing country’s National Hospital, combined with dedicated comprehensive surgical training camps.


Neurosurgery, anesthesiology, nursing, and clinical engineering personnel supported three training camps. More than 21 tons of essential equipment was delivered to New Mulago Hospital in Uganda. Data was collected during the 2-year period preceding and following the initiation of the program.


During the 2 years after the program began, neurosurgery demonstrated a significant increase (180%) in the number and complexity of cases performed (p < 0.0001). Multiple cases performed in a single day increased eightfold (p < 0.0001), with utilization of elective operating room days improving from 43 to 98%. There was no change in the number of hospital admissions over the 4 years (p > 0.1), but there was a dramatic increase in the overall number of procedures performed by all surgical specialties (106%, p < 0.0001).


Through a twinning program combining delivery of surplus equipment and training camps, capacity building was accomplished and maintained. The program not only built overall surgical capacity, it improved the efficiency and increased the complexity of operative cases performed at the National Hospital in Uganda. This program could serve as a model for twinning, capacity building, and training in other developing countries where surgical disparities are among the greatest.


Continue Medical Education Spinal Cord Tumor Training Camp Mulago Hospital National Referral Hospital 
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The authors acknowledge the extra work in preparing patients, performing operations and teaching nurses by Hussien Ssenyonjo, John Mukasa, Joseph Tindemwebwa, and Margaret Zomorodi. We thank Dr. Stephen Mallinga, Minister of Health, Dr. Samuel Kaggwa, Chief of Surgery, and Dr. Edward, Executive Director of Mulago Hospital, for preparing the way for all three camps and facilitating the surgeries and use of operating rooms. Funding sources included Duke University Health System Office of the Chancellor of Health Affairs (Victor Dzau, MD), Duke Global Health Institute, Duke Department of Surgery and Division of Neurosurgery, Promedical, Inc. (Winston-Salem, NC, USA), Synthes Spine Foundation, Integra Neurosciences Foundation, Operation Blessing (Norfolk, VA, USA), Biomet Inc., Baxter International, and the Pearl of Africa Benefits (Brooke Gleason). We thank the following: Sandra Serafini, PhD for help with statistical analysis in the manuscript: Certified Nurse Anesthetists James Temo and David Gleason for patient care on all three trips; Jean Bartis, RN, Teresa Cordero RN, and Pamela Borden, RN for leading operating room efforts on the three trips; Robbie Diggs and Ike Iketa Duke Clinical Engineers for refurbishing equipment and training Ugandan clinical engineers; Jenny Parker, the Head Administrator for all three trips; and Karen March, RN (Integra Neuroscience) for training ICU personnel.


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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Michael M. Haglund
    • 1
    • 2
    • 3
    Email author
  • Joel Kiryabwire
    • 4
  • Stephen Parker
    • 1
    • 5
  • Ali Zomorodi
    • 1
  • David MacLeod
    • 6
  • Rebecca Schroeder
    • 6
  • Michael Muhumuza
    • 4
  • Michael Merson
    • 2
  1. 1.Division of Neurosurgery, Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Duke Global Health InstituteDuke UniversityDurhamUSA
  3. 3.NeurobiologyDuke UniversityDurhamUSA
  4. 4.Department of NeurosurgeryNew Mulago HospitalKampalaUganda
  5. 5.Duke Global Health Residency Program, Duke Global Health InstituteDuke UniversityDurhamUSA
  6. 6.Department of AnesthesiologyDuke University Medical CenterDurhamUSA

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