Donating medicine to Haiti

Posted on January 18, 2010 at 11:45 am

This is an updated and edited repost of an earlier post
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When disaster strikes it’s natural to want to help in any way possible, and one of the ways that seems make sense is to donate medicine – either medicine from your own house, or expired medicine that can no longer be sold. However, before jumping into action there are some things it’s important to understand. The World Health Organization (WHO) developed Guidelines for Drug Donations so that the medicine you send is helpful rather than harmful.

Be sure you understand and follow WHO’s Guidelines for Drug Donations

How can a donation of medicine be harmful? Let’s look at a couple of the points in the guidelines and why they came about:

1. All drug donations should be based on an expressed need and be relevant to the disease pattern in the recipient country. Drugs should not be sent without prior consent by the recipient.

This guideline is based on the problem caused when crates of random drugs arrive in country. An acquaintance of mine working on the Hurricane Mitch recovery efforts told me about helping medical teams work late into the night sorting through random drugs, pulling out half used tubes of Preparation H and opened bottles of Prozac. Huge percentages of donated drugs are unusable and not only take critical time from medical personnel to sort but also cause a medical waste disposal problem. What do you do with hundreds of pounds of unusable drugs? Do you throw them out and risk garbage sorters taking them out and selling them on the street to kids? Do you flush them down the sink which risks the drugs getting into the ground water?

From the Global Post article Haiti: Help with money, not stuff discussing donations of medicine to Indonesia after the 2004 tsunami

In the end, most of the drugs had to be incinerated — you can’t simply send such a stock to the dump, where it would seep into the ground water and create another health hazard. That cost donors and the Indonesian government millions.

Don’t donate drugs that are about to expire.

WHO guideline #6.
After arrival in the recipient country all donated drugs should have a remaining shelf-life of at least one year. An exception may be made for direct donations to specific health facilities, provided that: the responsible professional at the receiving end acknowledges that (s)he is aware of the shelf-life; and that the quantity and remaining shelf-life allow for proper administration prior to expiration. In all cases it is important that the date of arrival and expiry dates of the drugs be communicated to the recipient well in advance.

WHO guideline #7.
All drugs should be labeled in a language this is easily understood by health professionals in the recipient country; the label of each individual container should at least contain the international Nonproprietary Name (INN) or generic name, batch number, dosage form, strength, name of manufacturer, quantity in the container, storage conditions and expiry date.

Many companies see donating expired drugs as a great way to help out, generate some positive publicity, and take a tax write-off by donating goods they would not be able to sell. However, although that may be great for the company, it is not great for the health professionals that receive crates of expired drugs that they legally cannot use but must store or dispose of. This rule allows for expired drugs to be sent only if the health facility is well aware of the status and still believes that the donated drugs will be more beneficial than harmful given their current circumstance.

Imagine if you worked in a rural health clinic in Kansas and received a shipment of medicine from Tajikistan with everything labeled in Farsi. How long would it take you to determine what medicine you’d received. Would you feel confident that you translated the labels correctly. Would you assume that you knew the correct dosage amount?  Would you be willing to give that medicine to your patients? The same problem occurs when we donate medicine with the labels in English. While well intentioned, these donations could cause more harm than good if the wrong medicine or the wrong dosage is prescribed due to language barriers. Again from Global Post article

Months after the aftershocks stopped, the French aid organization Pharmaciens Sans Frontieres (Pharmacists Without Borders) conducted a study of that second tsunami. In a world where most people lack adequate access to medicine, the results were a travesty.

The group found that although officials didn’t request any medicine, they received 4,000 metric tons of it, or more than 4 pounds for each person in the tsunami-affected area. There were multiple-year supplies of antibiotics, and palette loads of drugs unknown to health care providers. Seventy percent of it was labeled in a language that locals did not understand.

Drugs, like all other aid shipments, have to clear customs at whatever port they arrive at, and then be shipped to the actual aid site. Clearing customs can be both timely and expensive depending on national laws and tariffs. The cost of clearing goods through customs, storing, and shipping them can add up to more than it would cost to purchase the goods locally. Therefore your donation may actually cost the organization more then it helps them. If you are going to ship goods overseas you need to be very clear as to how all the associated costs will be covered. Again from the Global Post article:

A large depot near Aceh’s airport was so overwhelmed that mountains of pricey pharmaceuticals were dumped outside to rot under the monsoons and tropical sun.

WHO guideline #12.
Cost of international and local transport, warehousing, port clearance and appropriate storage and handling should be paid by the donor agency, unless specifically agreed otherwise with the recipient in advance.

The average person should not donate medicine after a disaster

Because of the cost and organizational demands needed to meet all of the guidelines created by WHO, donating medicine should only be done by organizations with the budget and capacity to do it properly. Before donating to an organization that distributes drugs look to see if they follow WHO’s guidelines.

UPDATE

Sharon McDonnell MD MPH, Dartmouth Medical School, provided some great examples and advice for drug donations in the comment section of the post 6 questions you should ask before sending donated goods overseas. She’s given me permission to include part of her comment here.

1. Donate only essential medicines. Most donated medicines are not essential medicines– as described by WHO list and good data on this from MSF and Management Sciences for Health. Essentially, medicines like cough syrup, anti-histamine syrups, and other liquids are heavy, a mess and detract from what is really needed.

2. We trained nurses, physician assistants, and physicians in many other countries and they learn about essential medicines and usually do not have access to expensive antibiotics. These medicines arrive and may or may not have their instructions with them– in English. The health workers and patients get them and often cannot read the labels
or warnings. The drugs are impossible to look up and are not available the following week. Thus, the health workers are unable to know what they are giving to patients. Health workers and patients need labels and materials that are in their language and can be adjusted for the specific patient. We needed good plastic bottles with good lids more
than anything.

3. We learned the hard way that labels coming with large donations may not be accurate (to put it nicely). We got a 50 gallon drum of blue pills from a US donor that was labeled as ferrous sulfate tablets– routinely given for iron deficiency in children and pregnant women. We used them for awhile but then decided to have them tested to be sure they were still chemically active. Turned out they were not iron tablets but pyridium (urinary antiseptic used to treat pain of urinary infections). We had unknowingly been given people something that was not helping their iron deficiency which can be life threatening but were exposing them to an unnecessary drug of no value. Fortunately, it is quite safe but does cause urine to turn bright orange and may have scared people.

4. The most difficult drugs are those for chronic diseases. These are expensive and usually need a “system” or program to dispense them. In disasters patients receiving treatment for epilepsy, high blood
pressure, diabetes, tuberculosis, AIDS/HIV, depression, schizophrenia, methadone maintenance, cancer chemotherapy or palliative medicines have few options and end up without their medications. Most relief agencies do not provide strong pain medicines, the stigma against mental health is such that few programs or agencies deal with it and no one donates drugs, and even the more routine medical treatments for “accepted” medical illnesses like hypertension and insulin are very hard to find since aid programs emphasis is on trauma care and infection only. We need to locate programs that are up and running that have the system and means to provide these medicines and then make sure they get them– Partners in Health has been doing it for TB and HIV they would be who I would start with to ask about getting these services in place and assured. Then donate the funds for those groups to purchase what they need.

Ditto to what has been said by many…. find people who know the ground and the people and help them do more better.

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Resources referenced in this blog:

Study of drug donations in the province of Aceh Indonesia – Pharmaciens Sans Frontiers – Looks at the problems caused by donations of medicine after the 2004 Southeast Asia tsunami

Global Post article Haiti: Help with money, not stuff

The challenge of reverse logistics in global health – A Humourless Lot - looks at the problems that arise when too much is sent or things have to be sent back

Related Posts:

6 questions you should ask before donating goods overseas

Four reasons to NOT donate baby formula overseas

The wost in-kind donations

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