The drama of the Thai soccer team trapped in a cave captured world attention and led to an extraordinary gesture on the part of billionaire Elon Musk. With a desire to help and access to vast technical and financial resources, he created a mini-submarine to assist in the rescue.
Unfortunately, the submarine was useless. As the lead British diver said, “It just had absolutely no chance of working. They had no conception of what the cave passage was like.”
{mosads}Donations of expensive but useless equipment are very common in the world of humanitarian aid, both at times of disaster and in the course of routine medical mission trips to poor countries. Equipment that is not usable in the environment where it is intended for use, like the mini-submarine, or that is donated without replacement parts or maintenance training, end up filling “medical device graveyards” throughout the global south.
The National Academy of Medicine has just published a discussion paper written by leaders in corporate and non-profit sectors addressing this issue. It points out the many barriers to effective and sustainable donations, including: a “mismatch between the types of equipment that are needed or usable and those that are received;” donation of equipment to a hospital that already has it; lack of alignment with local electric systems and outlets; lack of operating manuals; and the requirement of expensive purchase of parts and consumables to keep the equipment in operation.
They cite a 2011 study suggesting that 40 percent of donated equipment is not in use; the authors of that study point out that they may be underestimating the actual percentage of donations that are not being used.
The donors have good intentions; after all, why discard so much good material the way we do in the US when others could benefit from it? But how many of them realize that a great deal of the medical devices, equipment, and drugs they carefully collected and raised money for are useless — even worse, that they are ultimately more of a burden than a help?
Medical donations are an essential part of building health care systems in countries that cannot afford to do so on their own. They are also a big business. Dozens of agencies specialize in coordinating donations of new and used medical equipment, and thousands more organizations provide medical supplies as part of their short-term volunteer trips.
But just as common practices in global health volunteering are being critiqued and re-evaluated, leaders in the equipment donation realm are also questioning what they do and proposing better practices. Organizations such as MedSurplus Alliance and Partnership for Quality Medical Donations have been tackling these issues by working with major donors to encourage sustainable practices. The NAM report is an important landmark in this process.
Ultimately, host countries must control the importation of medical devices and supplies. The World Health Organization recently issued a series of guidelines for low income countries to develop more effective mechanisms for regulating device imports. And there are indications that this is happening.
A recently posted sign in the Entebbe airport in Uganda, for example, reminds visitors that the National Drug Policy and Authority Act of 1993 requires authorization for the import of any medicine or medical devices; unauthorized import is a “prosecutable offense.”
Thousands of health professionals, students, and church members arrive in Uganda every year, many of them with supplies and medications in their luggage. But Ugandan airport officials are now checking luggage more thoroughly than in the past, according to Jean Proehl of Project Helping Hands, and prosecutions would definitely change these practices.
While host country regulations are likely to become more prevalent and more regularly enforced, the onus is still on the donors to make sure they are not wasting their resources and burdening the institutions they intend to assist.
Judith N. Lasker is professor emerita of sociology at Lehigh University. She is the author of “Hoping to Help: The Promises and Pitfalls of Global Health Volunteering.”