E-drug: Pills to Africa: how to donate effectively
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[The never ending story of bad donations. It only needs someone to be out
there in the field to have the story repeated all over again in spite of
guidelines and signatories to them etc. KM]
BMJ 2001;323:1315 ( 1 December )
Reviews
Personal views
Pills to Africa: how to donate effectively
It's amazing what you can find in the pharmacy of a rural mission hospital
in Africa. Many are heavily dependent on the generosity of supporters in
the
northern hemisphere for valuable supplies of antibiotics, diuretics, and
oral hypoglycaemic agents. Unfortunately, well intentioned, but
inappropriate donating can also turn developing world hospitals into
dumping
zones for pharmaceutical junk, sent on the basis of "anything must be
better
than nothing."
Guidelines for responsible donating
Donors
Ask first before collecting/despatching
Seek advice on the best method of transportation and completion of customs
declaration form
Discuss local policies on expired and near expired items, antibiotics,
antivirals, and psychotropic drugs
Enclose an itemised list in the official local language, including generic
drug names (recipients may not be familiar with trade names) and
information
on shelf life.
Recipients
Investigate if your country has its own drug donation guidelines
Ascertain information on the local policy regarding expired products
Send a copy of the local drug policy/essential drugs list to your regular
donors or a shopping list of useful products
For equipment, consider practical details such as "What will it plug
into?",
"How will it be maintained?", and "Who will benefit from it?"
Learn to say "No" without fear of causing offence.
Twenty days' worth of small packs of doctors' free samples of the latest
calcium channel blocker will not control a patient's hypertension for long,
but might fill a gap while stock of a diuretic is awaited. Six vials of a
third generation cephalosporin that have passed their expiry date may
breach
local policy, but, faced with a child with meningitis failing to respond to
penicillin, could save a life. However, the Zambian mission hospital in
receipt of a box of amphetamine based appetite suppressants would no doubt
still be awaiting a suitable candidate had they not been consigned to the
bin.
Anyone employed in the health sector of industrialised countries
experiences
a disposable culture that contrasts sharply with the needs of hospitals in
the less developed world, where surgical gloves may adorn washing lines
awaiting a second or third visit to the autoclave for resterilisation. Many
theatre nurses in the northern hemisphere faithfully collect unused gloves
and suture material to send to health institutions that can make use of
them. Some with greater ambitions appear to be encouraging operating
theatres in Malawi and Uganda to extend their surgical repertoires by
dispatching many metres of cardiopulmonary bypass tubing to them.
Of course, recipient hospitals are free to dispose of donated items that
they cannot use, but even this can become an administrative headache.
Facilities for safe storage and disposal of medications may not be
available. In large quantities medications can become a chemical waste
problem threatening environmental contamination. Venezuela struggled to
deal
with huge quantities of medical aid donated after floods and landslides two
years ago. Costly disposal measures have also been required in Armenia,
Mostar, and Kosovo.
Swingeing import duties and transport costs have often turned a consignment
designed to bless into a bureaucratic curse. Negotiating with a department
of customs and excise can be a time consuming and morale sapping process.
It
took a colleague in Uganda two years to clear a consignment of medical
supplies. On final inspection, officials then found the expiry date of a
large quantity of surgical gloves to have passed and slapped the surgeon
with a bill to cover the cost of destruction of the offending items.
The World Health Organization recently updated its guidelines on drug
donations and urged donors to ensure that their donations are of maximum
benefit to the recipient; respect the wishes and authority of the
recipient;
strictly avoid any double standards in quality; and are based on effective
communication between donor and recipient. Six donor countries and 13
recipient countries have now developed their own drug donation guidelines.
Good drug donations save lives and are much needed, especially in times of
crisis. The indirect benefits should not be underestimated either. The
collection of drugs and medical products can act as a focal activity for
supporters and donators, promoting interest in the work of a mission
hospital or relief organisation and a sense of meaningful participation.
John H Day, clinical research fellow,
Aurum Health Research, PO Box 87, Welkom, 9460, South Africa
jd@aghs.co.za
Christopher B D Lavy, consultant orthopaedic surgeon.
Malawi Against Physical Disability, PO Box 256, Blantyre, Malawi
lavy@malawi.net
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