Neurosurgical Needs and Assets Assessment of Public Hospitals in Uganda: An Eevaluation of Mulago Hospital to Inform Neurosurgical Program Planning at Mbarara

Background: Since 2007, there has been an ongoing collaboration between Duke University and Mulago National Referral Hospital (NRH) in Kampala, Uganda to increase surgical capacity. This program is prepared to expand to other sites within Uganda to improve neurosurgery outside of Kampala as well. This study assessed the existing progress at Mulago NRH and the neurosurgical needs and assets at two potential sites for expansion. Methods: Three public hospitals were visited to assess needs and assets: Mulago NRH, Mbarara Regional Referral Hospital (RRH), and Gulu RRH. At each site, a surgical capacity tool was administered and healthcare workers were interviewed about perceived needs and assets. A total of 39 interviews were conducted between the three sites. Thematic analysis of the interviews was conducted to identify the reported needs and assets at each hospital. Results: Some improvements are needed to the Duke-Mulago Collaboration model prior to expansion; minor changes to the neurosurgery residency program as well as the method for supply donation and training provided during neurosurgery camps need to examined. Neurosurgery can be implemented at Mbarara RRH currently but the hospital needs a biomedical equipment technician on staff immediately. Gulu RRH is not well positioned for Neurosurgery until there is a CT Scanner somewhere in the Northern Region of Uganda or at the hospital. Conclusions: Neurosurgery is already present in Uganda on a small scale and needs rapid expansion to meet patient needs. This progression is possible with prudent allocation of resources on strategic equipment purchases, human resources including clinical staff and biomedical staff, and changes to the supply chain management system.

A REPRESENTATIVE OUTSIDER AND THE INCLUSION OF THE OUTSIDER IN ACTS 8:26-40

In Luke’s two volumes, Luke is not interested only in Gentiles and those with high social status but also in the marginalized and those who are outsiders. This dissertation seeks to read Luke’s concern for outsiders and the theme of the inclusion of outsiders in the new kingdom of God in Luke’s narrative of the Ethiopian eunuch’s conversion in Acts 8:26-40. This paper examines the Ethiopian eunuch’s complex identity from the perspectives of the Greco-Roman world, Old Testament (LXX) allusions to the Elijah-Elisha narratives, and Luke’s interpretation of the Isaianic quotation of the Suffering Servant in Acts 8:32-33 (cf. Isaiah 53:7-8). This study pays close attention to the correlations between the theme of outsiders and three key characters in Acts 8:26-40: the Ethiopian eunuch, Philip, and the Suffering Servant. First, Luke depicts the Ethiopian eunuch as the consummate outsider—geographically, morally, socially, ethnically, and in terms of gender—and indicates that the eunuch represents other marginalized outsiders. The eunuch shows no one can prevent outsiders like him from inclusion in the kingdom of God. Second, Luke portrays Philip as a prophet, specifically a prophet like Elijah and Elisha. Philip emulates Elijah and Elisha by reaching out to the outsider (in this instance, the Ethiopian eunuch). Third, Luke presents the Isaianic Suffering Servant as a religious and social outsider and identifies the character with Jesus and the Ethiopian eunuch. The indescribable descendants of the Suffering Servant signify a universally inclusive messianic community and fulfill the outsiders’ inclusion within the people of God as Isaiah prophesied (Isaiah 56:3-8). This thesis finally suggests ways to read the story of the Ethiopian eunuch today and concludes that it is imperative to include those outsiders among us within the community of Jesus’s followers.