Fixes looks at solutions to social problems and why they work.
Bruce CharashA boy suffering from cerebral malaria was treated at the Hubert Maga Hospital in May 2007. Donated supplies arrived just in time to save his life.
When Dr. Bruce Charash arrived in Cotonou, Benin, in May 2007, he went from the airport to Hubert Maga Hospital. Charash is the founder of a Brooklyn-based organization called Doc2Dock, which collects surplus medical equipment from hospitals in the United States and ships it to hospitals in poor countries. As Charash’s plane was landing, a container of medical equipment and supplies had docked, destined for Hubert Maga.
At the hospital, patients were lying on the floor. The entire hospital had one stethoscope. There was no soap. Every patient getting blood drawn shared the same needle. In the pediatric ward, there was a little boy, perhaps 4 or 5 years old, lying in bed with blank eyes. He had cerebral malaria. The hospital had bottles and bottles of a medicine, donated by the United States., that could save him. But the boy could not take it, because Hubert Maga Hospital had no intravenous lines.
As Charash was touring the hospital, the container of supplies arrived. People unloaded an anesthesia machine, exam table, C.P.U. monitor, two pediatric dentists’ chairs, hundreds of boxes of medical instruments, surgical kits, syringes, gauze, gloves, sutures ― and IV lines, about 5000 of them. The boxes were ripped open and IV lines rushed to the pediatric ward.
Two days later, a healthy little boy went home.
Every year, hospitals in America throw away thousands of tons of usable medical supplies and equipment — by some measures 7,000 tons a year, a value of $20 billion. The 2006 model ultrasound machine is sent to a landfill because the 2011 model has arrived. Unopened, sterile packages of supplies are thrown away because they were marked for one patient’s surgery and hospital regulations prohibit their use by another.
Yet every year, hospitals in developing countries around the world turn away patients or provide substandard care because they lack even the most basic medical equipment.
For many problems in the world, a solution already exists — somewhere else. In those cases, what’s needed is a way to connect supply with demand. Sometimes it’s buyers and sellers — potential customers in wealthy countries are interested in the jewelry and crafts made by indigenous artisans; the Worldstock market at Overstock.com is one way to bring the two together. It can be lenders and borrowers —Kiva.org, for example, connects people with small amounts of money who want to make microloans with people who need, say, $100 to buy chicken feed in Uganda. Last week’s Fixes columns by David Bornstein showed the value of a systematic way to connect social services to those who need them. In a familiar version of the model used by Doc2Dock, food banks collect usable surplus food from restaurants and banquets and deliver it to pantries for the hungry. In fact, A.B. Short, the co-founder and chief executive of MedShare, one of the largest of the surplus medical supply groups, used to work for the Atlanta Community Food Bank.
Often what’s required is just to move money or information. That’s relatively easy. It’s a much bigger challenge to get a mammography machine no longer needed by a hospital in Atlanta to a hospital in Ecuador. You have to collect the equipment, check to make sure it’s in good condition, store it somewhere, pack it into a container and put it on a boat, get it through customs when it arrives and ship it by truck to the hospital. You also have to make sure the hospital needs a mammography machine, enjoys consistent electricity and has personnel trained to use the machine.
Doc2Dock is one of several organizations that do this work. The biggest ones are Project C.U.R.E. in Denver (with whom Doc2Dock often works) and MedShare, based in a suburb of Atlanta, which has shipped 696 containers to 87 countries and territories. Doc2Dock, one of the newer groups, was started largely with the personal savings of Charash, who had been the director of the cardiac care unit at Lenox Hill Hospital in Manhattan. It sent its first shipment, to Agogo Presbyterian Hospital in Ghana, in September, 2006, and has now shipped 40 containers to 13 countries. It is the major organization collecting from hospitals in New York City, the country’s biggest hospital market.
There is plenty of room for growth. Only a small percentage of hospitals have some organized way to deal with surplus equipment and supplies. Donating surplus goods is intrinsically attractive to hospitals — and it reduces the tonnage they must send to landfills.
Hospitals are not the only ones who donate. MedShare gets 65 percent of its cargo from manufacturers or distributors of medical equipment and supplies. A small puncture in a carton may mean that a box can’t be shipped to a paying customer, even if the supplies are still individually wrapped and sterile.
The surplus supply groups collect the donations at a central warehouse, where armies of volunteers — sometimes classes of high school students — sort and pack them. They are bar coded and stored. Doc2Dock has only a small warehouse in New York, but Wal-Mart picks up the cost of shipping the rest to its warehouses in Tennessee and stores it there. The supplies and equipment are packed in a 40-foot container. A typical container from Doc2Dock would carry 12 hospital beds, two delivery tables, an operating room table, anesthesia machine and 800 boxes of supplies such as syringes, IV fluid and lines, gauze and gloves. Sonogram machines for prenatal care are a frequent request, as are anesthesia units.
The groups find recipient hospitals and learn what these hospitals need by sending staff to visit, or they rely on a trusted nongovernmental organization in that country to make the visit.
The visitors check for dependable electricity and doctors and nurses who are trained to use the equipment. They look at the hospital’s equipment and talk to staff about their wish list.MedShare even has an online catalog of its inventory for hospitals to order from.
More From Fixes
Read previous contributions to this series.
Most groups like to develop repeat customers. MedShare is a regular supplier for the network of surgical hospitals for children with disabilities in Africa run by CURE international. Mark Bush, chief operating officer of CURE, said that its network of 11 hospitals receives about 10 to 12 containers a year from various organizations. MedShare, he said, does the best job of sending exactly what CURE needs. The shipments save CURE several million dollars a year, and allow it to get more sophisticated equipment than it would otherwise buy –making possible more and more advanced surgeries.
One issue that rarely comes up is lack of training — even in the poorest countries, doctors and nurses study on modern equipment, and are eager to get a chance to use it. Charash was in Ghana to see the arrival of a sonogram machine at Tapa District Hospital. The hospital needed one so badly that the community had taken up a collection, a nickel at a time, to buy one — a process that would have taken 10 years to produce a machine. When the container arrived in 2008, the machine was the first thing unloaded. Doc2Dock videotaped Dr. Isaac Boateng, the hospital’s chief medical officer and only gynecologist, as he used it for the first time. “That is the spine on the fetus … there is the head … we know we are not dealing with a breech presentation,” he murmured as he ran the probe over the belly of Abigail Kuffour. “The guy looked like he could have been chief of OB-GYN at Johns Hopkins,” said Charash.
Bruce CharashDr. Isaac Botang performed the first sonogram at the Tapa District Hospital in Ghana.
Sending needed surplus medical supplies to poor countries is an elegant concept. But it is not the antidote for the barren conditions of many third-world hospitals. It is a piecemeal solution, covering a tiny percentage of hospitals that need it — and a temporary reprieve even for the hospitals that are reached. Supplies run out. Machines break — and most will have very little chance of being repaired. On Wednesday, I’ll respond to comments, and write about how the surplus medical supply groups are grappling with these problems.
Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and now a contributing writer for the paper’s Sunday magazine. Her new book is “Join the Club: How Peer Pressure Can Transform the World.”