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Duke ICU team helps Ugandan patients recover from the aftermath of neurosurgery

Friday, November 10, 2017

Kampala, Uganda -  For the patients lucky enough to get it, brain surgery is only the beginning. Urgent medical care is needed to cope with the complications from the operation, from blood loss, to restoring consciousness and body temperature, to dealing with symptoms from nausea to vomiting.

Yet in Mengo hospital and other locations in the developing world, this care is almost an afterthought. Intensive care teams dealing with surgery patients operate under heavy workloads, with fewer resources and equipment available than in developed countries, and with little training.

Carmelo Graffagnino, MD, and Duke Neuro Intensive Care Unit (ICU) nurses Christine Locascio, Danielle Runnels, Charles Spencer, and Ashby Hayes recently traveled to Uganda's capital to make it easier for doctors and nurses in Mengo hospital provide that care.

Their trip was part of a larger ongoing effort from Duke Global Neurosurgery and Neuroscience (DGNN). For the past decade, DGNN’s founder, neurosurgeon Michael Haglund, MD, PhD has worked to help improve infrastructure and training for neuroscience care in Uganda and its neighbor Kenya. By providing training, equipment and logistical help, Haglund hopes to improve the Ugandan health system’s ability to provide neurosurgical care. Read more about DGNN here.

Haglund’s previous efforts have included purchasing remaindered but functional equipment from the U.S. and shipping it to Uganda, establishing a neurosurgery residency program in Uganda, and providing direct, hands-on training to doctors and nurses.

During their week-long visit, Graffagnino’s team worked side-by-side with Ugandan providers in Mengo Hospital’s ICU. Together they treated patients recovering from surgeries Haglund and his team were performing with Ugandan neurosurgeons.

To make the most of his time, Graffagnino also led an impromptu clinic in the mornings. Every morning a small empty clinic room soon filled with patients hoping to receive care. “I must have seen more than 50 consults with everything from epilepsy to stroke to movement disorders to stroke every day I was there. It was a real neurology blitz,” Graffagnino said.

One of the patients Graffagnino saw underwent an extended seizure in the waiting room. Graffagnino was able to sedate the patient and treat the seizures. The patient had been experiencing seizures for years after a terrorist attack at a soccer match left him with a severe skull injury. Until he saw Graffagnino, his treatment had consisted of mostly useless homeopathic medications.

“The beautiful thing is that after I left the patient somehow tracked down my email address to thank me and let me know he’s doing well,” Graffagnino said. “Knowing that I’ve been able to make that kind of difference makes my job so rewarding.”