[e-drug] Inappropriate donations to Aceh

e-drug
1

E-DRUG: Inappropriate donations to Aceh
---------------------------------------

[When I speak about the need for Guidelines for Donations, people often say 'but do you have any recent examples?' Here is a very recent example. Beverley Snell, Moderator]

Australian Broadcasting Corporation (ABC) News Online
Last Update: Thursday, June 9, 2005. 11:27am (AEST)

Tsunami aid breast implants 'inappropriate'
[copied as fair use]

An Australian medical specialist says a large amount of donated supplies, such as breast implants, sent to the tsunami-effected region of Banda Aceh are clearly inappropriate and will never be used.

Jan Rice, from Monash University's Victoria College of Pharmacy, travelled to the area with AusAID three months after the disaster to assist and educated staff at the general hospital.

Ms Rice, who specialises in wound care, says some of the goods donated were not used because of drugs being out of date, or supplies such as breast implants being inappropriate for the devastated area.

She says the hospital was overwhelmed by the sheer volume of donated medical supplies and sent it to a nearby storeroom.

"I found a box with breast implants in it and drugs out of date," she said. "So ceiling-to-floor of donated boxes in various states of disrepair because the humidity's 120 per cent and cardboard obviously softens, so if there were heavy items in the box, then the bottom would've fallen out of it and then the box would've been carried into an area and then just dumped in there.

"We had various equipment that was not complete so there were parts
missing so that couldn't be used.

"Some fairly intricate intensive care equipment but they didn't have
an intensive care unit and they didn't have intensive care-trained
staff."

2

E-DRUG: Inappropriate donations to Aceh (2)
-----------------------------------------------

Dear E-Drug recipients. Guidelines for Donations sounds perfectly reasonable
and may be helpful to the majority of humanitarian groups who are dedicated to
health care ethics and seriously take the time to find out how to be helpful
following natural or man made tragedies. However, my first hand experience of
the situation in Aceh over the last 5 months leads me to believe something far
stronger than guidelines is required, to stem the flow of inappropriate drug
and medical supplies that follow on from tragedies.

We have had WHO guidelines for a long time but some groups choose to ignore the guidelines and the lessons learnt from past responses to tragic situations. Whilst one understands recipient governments wanting to be receptive to humanitarian assistance, more
research data is required to demonstrate the true costs of inappropriate medical supply donations on recipient governments and hence help these governments to make informed judgements about what can be received and what should possibly be rejected. The increased resources in sorting, inventory, storage, and then disposal of inappropriate supplies can easily run into greater costs than associated with procurement of medical supplies actually
needed to respond appropriately to tragedies.

There was no shortage of medical supplies in Indonesia following the tragic earthquake and subsequent Tsunami that could if required could have been reassigned from other areas or purchased in country to overcome shortages in any particular areas. Cash donations are of course very welcome to faciliate quick response to assist needy people.

I suggest something as strong as a UN resolution against inappropriate medical
supply dumping may be required to curb practices that not only have negative economic implications (especially on local businesses) but may have even more negative health related outcomes especially if irrational drug use leads to even more drug resistance, morbidity or worse.

Dr Phillip Passmore
Director
Pharmaceutical Services Management International Pty Ltd
PO Box 392
Como 6152
Western Australia
psmint@iinet.net.au

3

E-DRUG: Inappropriate donations to Aceh (3)
------------------------------------------------

  Dear friends,

   It is very unfortunate but revealing that inappropriate donations are still taking place, specially after these many years of effort to address this practice. I believe there is hardly anything impractical in the message for appropriate donation practice, but could it be that investment in this area has fallen by the wayside (probably because it is not an 'exciting' arena of healthcare, or supply)?
   
Regards,

   Bonnie
   Bonface Fundafunda PhD, MBA, B.Pharm(Hon)
  Birkevej 32, Tranegilde Strand, 2635 Ishoj, Denmark
"BONFACE FUNDAFUNDA" <bcfunda@hotmail.com>

4

E-DRUG: Inappropriate donations to Aceh (6)
------------------------------------------------

Dear E-druggers,
Whilst there is a lot of value and sense in what Phillip says, certainly from a point of view of importance of this problem, we should also remember that are countless number of UN resolutions with potentially more catastrophic global consequence, "nuclear" comes to mind, which have been ignored in the past.

It seems to me that a key problem will continue to be how empowered recipients are, even in the face of extreme adversity, such as in Aceh, to say "No" to bad donations. Let us remember that resolutions at the UN are tabled by member states. Perhaps this is where should start
good practices, well before disaster strikes again as it will.

Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division

Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply

5

E-DRUG: Inappropriate donations to Aceh (7)
------------------------------------------------

Point of clarification? Do you mean by this Murtada, that "a" member state
must pull this together to the point of a resolution and then have it
submitted? It sounds like the process should begin, as the next disaster
will or will not conveniently announce itself?
I'll vote for not announcing itself or when it will arrive.

Stevan Gressitt, M.D.
USA
Gressitt@uninets.net

6

E-DRUG: Inappropriate donations to Aceh (8)
----------------------------------------------------

Stevan and e-druggers,
I was trying to emphasize that whether by UN resolution or WHO Guidelines,
the ultimate responsibility will always rest on the countries/
governments/local authorities/local professionals/communities etc " to make
things work. The absence of this continues to be the weakest link, in my
view. I am sorry that I may not have made this view clear.

Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division

Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply

7

E-DRUG: Inappropriate donations to Aceh (9)
---------------------------------------------

Dear E-Druggers, I raised the idea that a UN resolution may be a more effective
way to reduce or prevent inappropriate medical supply dumping because up to now
this problem has not been resolved by much debate,guidelines, published "true
life horror case studies" or even pleading with certain groups to discontinue
the practices.

Before we get bogged down in the fine tuning of whether it is a
UN resolution or any other means the issue is accepting that the problem is
enormous and that it will take large measures to resolve the problem. I did
state that more research is needed to determine real costs (economic, social,
medical) associated with the practice of dumping. I use this term guardedly but
the term donation, according to the Oxford dictionary implies a meaning to
help.

It is very difficult to imagine how some groups were thinking of help
when they loaded up a large number of the pallets without first enquiring if
the goods would help or hinder the situation. This is often a difficult debate
because one can run the risk of being accused of insulting someones elses
motives following tragedies that require fast efforts to support hurting
people. I feel we may gain further support if we can determine and publish
costs, as it seems when you talk money you get more attention

Dr Phillip Passmore
Pharmaceutical Services Management International Pty Ltd
PO Box 392
Como 6152
Western Australia
psmint@iinet.net.au