Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
World J Surg. 2011 Jun;35(6):1175-82. doi: 10.1007/s00268-011-1080-0.
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.
在东非国家，神经外科能力极其匮乏，27 名神经外科医生为超过 2.5 亿人服务。为了建立能力，杜克大学医学中心和乌干达的新穆拉戈医院采用了双管齐下的结对方法，将可用的剩余设备放置在发展中国家的国家医院，并结合专门的综合外科培训营。
神经外科、麻醉科、护理和临床工程人员为三个培训营提供支持。超过 21 吨的基本设备被运送到乌干达的新穆拉戈医院。在该计划启动前和启动后的 2 年期间收集了数据。
在该计划开始后的 2 年内，神经外科手术的数量和复杂性显著增加（180%）（p<0.0001）。单日完成的手术数量增加了八倍（p<0.0001），择期手术室天数的利用率从 43 天提高到 98%。在 4 年期间，医院入院人数没有变化（p>0.1），但所有外科专业完成的手术总数显著增加（106%，p<0.0001）。
通过结合剩余设备交付和培训营的结对计划，完成并维持了能力建设。该计划不仅建立了整体外科能力，还提高了乌干达国家医院手术的效率并增加了手术的复杂性。该计划可以作为其他发展中国家结对、能力建设和培训的模式，这些国家的外科差距最大。
