Monday, September 5, 2011

Hospital Donations Overseas

In her post in the New York Times, Making Medical Donations Work, Tina Rosenberg discusses ways to maximize and make sustainable humanitarian aid. The article specifically targets the ups and downs of sending expensive equipment and medicines abroad. In my experience conducting site visits in foreign hospitals in advance of medical teams and as a manager of surgical missions, I'd like to share a few things I've learned along the way.

To begin, and this is mentioned in the article, don't donate expired medicines or equipment or send along equipment that barely functions. It will just end up trashed, taking up space or eroding your goodwill.

All humans are opportunists. If you are giving something away, people will take it, even if it is not what they need. Let's say the hospital needs an x-ray machine but you have an anesthesia machine to donate. They'll take it - perhaps it will be used someday, perhaps not. I've seen a lot of expensive machinery sitting unused because no one has been trained to use it, parts are broken, there is intermittent electricity, film/ink/whatever needs to be replaced and is unavailable, etc. etc. The same is true of drugs: supplies of medicines sitting on shelves and used sparingly if at all as the supply is finite and the clinic/hospital/health center doesn't want to run out.

If you give, be sure you can train people to use and/or maintain the equipment. If you send a dermatome machine, they are going to need blades eventually, keep that in mind.

When I tour operating rooms examining the equipment so that our doctors will know how to prepare for their missions, I often see very nice equipment. I have learned to ask a basic question: does it work? I cannot tell you how many times the answer is 'no.' Perhaps there are three operating rooms that will be available to the team, but only one or two working anesthesia machines. Or, I will ask if the electricity ever cuts out (this happened on a trip in Vietnam in the middle of an open-heart operation). Is there a generator? How long till it kicks in? What can it support?

At this end, when  we hear the word "hospital" (or "doctor" or "nurse") we have certain expectations and assumptions. Best not to assume. I always say you have to stop thinking like an American on these trips. Doctors and other medical staff are doing their best under circumstances most medical personnel here would find not only challenging but debilitating. They see severely ill and injured patients they are at times unable to provide care for because they lack a few basic items. Which brings me to this: donations do not have to be huge to be effective. Everyday over-the-counter medicines have their place too. Hospitals always need supplies, like sutures - you don't have to think big and expensive to be helpful.

If you want to help, I believe it is important to have someone on the ground you can trust to facilitate your work overseas. Follow-up, visit and be sure you get accountability. Sometimes the best you can do is get close to the truth - and sometimes that is enough.

Click on the title to read Making Medical Donations Work from the New York Times.

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