They aren’t on.

“They’re old, so they break down soon,” Justine informs me matter-of-factly as we survey the carnage. 13 of the 20 incubators are broken.

The instructions for one are in Dutch. Ugandans typically speak Luganda, Kiswahili, and English.

Mulago’s experience is not unique. Across Sub-Saharan Africa, “medical device graveyards” litter the empty closets and spare corners of hospitals. The World Health Organization estimates that “a large proportion (up to 70 percent) of equipment lies idle.” Another study pegged a lower, still troubling figure of 38 percent.

Speaking with four major equipment donation organizations gave a vastly different impression than on-the-ground visits to 20 hospitals. Despite the best intentions of these organizations, the system is not working. Good intentions are not enough.

As one administrator bluntly put it, “Donations just do not work. That is almost always the case.” (Like many of the physicians and administrators I spoke with, this one did not want to be named, for fear of seeming ungrateful.)

Things can get better, though: with a few simple changes to the process, improper and useless donations can be reduced.

But a larger question looms: even with improvements, is this how aid should be delivered?

***

Bwindi Community Hospital (Mike Miesen)

Bwindi Community Hospital is an orderly, wonky hospital (pie charts of funding sources and admission figures greet patients at the entrance) tucked into the breathtaking green expanse of southwest Uganda’s Bwindi Impenetrable National Forest.

Dr. Kurigamba Gideon, a lanky physician administrator prone to a wide smile and a quick joke, showed me around. The pediatric ward was covered in colorful wall paintings, below which a nutritionist taught new mothers how to make a special recipe to treat acute malnutrition. Next door, the maternity ward was clean and quiet, and one corner was home to a suspiciously large number of medical devices.

All were inoperable. This was Bwindi’s own device graveyard.

One donated anesthesia machine in particular was infamous: It was used on “only one patient before it stopped working,” Kurigamba explained to me. “It was just a mess.”

The perception on the ground is that some donors “dump” useless junk equipment—a phrase I heard from multiple administrators. “It was dumping, actually. That’s what it was,” Kurigamba added.

All of the equipment donation organizations I spoke with condemned dumping as wasteful and expensive.

International Aid, a Michigan-based Christian non-profit that refurbishes medical equipment and ships it abroad, has a frank philosophy on donating:

“Don’t send ‘Junk for Jesus,’ you know?” its medical equipment services director, Jim Loeffler, said.

Most of the equipment organizations such as International Aid receive is second-hand, so many have biomedical technicians on staff to recondition the devices.