Charity cases: Medical services and equipment at rock bottom prices

December 19, 2011
by Diana Bradley, Staff Writer
This story originally appeared in the December 2011 issue of DOTmed Business News.

A four-year-old boy lay dying of malaria in a Benin, West Africa-based hospital. Not 40 feet from his room, a supply closet is fully stocked with the antidote. But the hospital has no basic intravenous lines available to administer the drug. In a country where one out of five children die from malaria before the age of 10, this little boy’s story is all too common.

Meanwhile, every day across the U.S., 7,000 tons of reusable or unused medical devices are discarded and sent to landfill.

Enter Doc2Dock – a Westbury, New York-based Clinton Global Initiative nonprofit that has been collecting and redistributing medical supplies and equipment to underserved countries since 2006. Because of this organization, the Benin boy was supplied with an IV, got his medicine, went home and avoided becoming another sad statistic.

“Our mission is to correct an imbalance,” says Dr. Bruce Charash, Doc2Dock’s founder.

The U.S. is a privileged nation; our Marriott hotels change their furniture every four years because people want new. It’s the same in U.S. hospitals, according to Charash.

“American hospitals get rid of capital medical equipment for cosmetic reasons,” he said. “It can be that equipment is just not up to snuff for what is expected from more or less affluent communities; or that the next technology has come around and we’re prepared to give up the old machine for a new one.”

Doc2Dock collects capital equipment and consumable supplies. Ultrasound equipment is the most desirable, along with delivery tables and autoclaves. Although it costs $25,000 on average to pack and deliver containers to Africa, the wholesale value of the supplies Doc2Dock sends is $500,000.

“I’ve been in hospitals where surgical gloves are washed, hung and reused; in the Congo, they work with blood-covered operating instruments,” said Charash. “Beds are equally as important – in Africa, one out of four people sleep on the floor because there aren’t enough beds available in hospitals.”

The organization regularly collects these supplies through operating room recycling bins. Charash noted that most surgical procedures involve a pre-assembled kit, overstocked by 30 percent or more in case the surgery runs longer than expected. When finished, every item must be discarded, even though each item is individually wrapped and sterile.

“A lot of the surgical stuff nowadays is pre-packaged,” said Theresa Suits, executive director of Project C.U.R.E.’s (Commission on Urgent Relief and Equipment) New York wing – an organization with 15,000 volunteers and 11 collection centers throughout the United States, donating medical equipment to more than 120 countries since 1987. “Anything like that is considered excess; it can’t be reused in the U.S.”

Alternatively, hospitals and clinics might upgrade their equipment, according to Bridget Boyd, Project C.U.R.E.’s communications manager.

“America is regulated by medical insurance and the FDA and there’s very strict criteria that’s much more lax in these third-world countries,” said Suits. “The stuff that ends up in our dumps is like gold to these people -- it’s literally saving lives.”

But it’s not just a case of boxing and sending off equipment – it must be sorted, needs assessed and hospitals must be analyzed to see what they have, what needs replacing and if staff are properly trained. Doc2Dock also has a voluntary biotechnician who certifies that the equipment works.

“We don’t just send a gift basket to a hospital,” said Charish. “We don’t want to supply dump – sending 800 boxes of catheters could actually end up being more devastating to a clinic because they’d have to pay to get rid of them.”

For a medical facility requesting assistance, Project C.U.R.E.’s detailed pre-qualification process requires proof of a financial sponsor. A comprehensive onsite assessment is then conducted to determine the specific needs of the medical facility, making sure it’s able to install, use and maintain equipment successfully.

“We wouldn’t send an ultrasound machine to a clinic in the middle of New Guinea that has no electricity,” Boyd said. “That’s where these assessments come into play.”

According to a 2009 University of Denver study surveying Project C.U.R.E.’s medical supplies and equipment recipients, 100 percent had increased community confidence in their facility; 100 percent were able to internally reallocate finances to at least two other needed areas including direct patient care (94 percent) and workplace hygiene (71 percent); 94 percent reported being able to offer more types of procedures; and 88 percent reported being able to offer more services and procedures.

Doc2Dock has also seen improvements in the 15 countries it donates to. Most recently, the organization sent five containers of equipment to Lubumbashi, Katanga – a place Charash described as worse than Haiti.

“In the first three months with the containers, they saw a 25 percent increase in hospitalizations; a 60 percent increase in outpatient clinical visits; and a 38 percent drop in infant and pediatric mortality,” said Charash.

Aside from the immense impact donated medical equipment has on needy patients in other countries, Suits noted that it encourages recycling in the U.S.

“While donating medical equipment saves lives in another country, it also keeps things out of the local landfill -- it’s a win-win situation,” she said.
Helping the helping hands
Along with sending equipment, Project C.U.R.E. also sends people to provide free medical aid in underserved countries through its C.U.R.E. Clinics program.

But due to time constraints, medical volunteers can be hard to enlist. In 2004, the American College of Surgeons established Operation Giving Back -- an initiative that strives to provide a supportive forum for volunteers through its website -- preserving outreach avenues, creating additional resources to facilitate surgeons’ involvement and recognizing volunteers’ contributions both towards individual patients and on a societal level.

“Ultimately, the goal is that every surgical patient gets the safe, quality, timely, and appropriate care they require – this will be an ongoing challenge,” said Dr. Kathleen Casey, director of Operation Giving Back. “A more specific goal of OGB is to facilitate surgeons’ involvement, both internationally and in the U.S., towards this end.”

Many medical professionals consider volunteering integral to their professional identity, according to Casey. But barriers can prevent them from volunteering at various points in their lives.

“I speak to many surgeons who are not currently involved in these outreach activities, but would like to be,” Casey said. “We are working to define their barriers with an aim to reduce or remove them through advocacy and education. I think far more surgeons are involved or would like to be involved in these activities than are appreciated.”

To show its appreciation of ACS Fellows and members whose volunteer work has made a lasting impression, the ACS, in association with Pfizer, Inc., annually holds the Surgical Volunteerism and Humanitarian Awards. This year, Dr. Girma Tefera, MD, of Madison, WI, received the 2011 Surgical Volunteerism Award for international outreach in recognition of his contributions toward improving the delivery of surgical care in Ethiopia.

“There is an African proverb that says: ‘Man’s medicine is man,’” said Tefera. “Volunteer work in global health is a unique opportunity for an American health care worker to learn about different cultures, develop new friendships and most importantly, an opportunity to learn how to function in low-resource conditions and learn to appreciate what we have in this country.”

Louis L. Carter, MD, of Chattanooga, TN, won the 2011 Surgical Humanitarian Award in recognition of a lifetime of service to the underserved, spanning nearly five decades, 20 countries, and 74 mission trips. Carter has left a legacy of surgeons, nurses, and other medical professionals who are equipped with the knowledge and skills to care for hand injuries, burn contractures, cleft lips and palates, and other correctable debilitating conditions.

“I’m not proud of anything,” said Carter. “I just saw the needs of disabled and deformed people overseas that had no care at all and I wanted to help.”

Charity begins at home
In September, the Census Bureau reported that 49.9 million Americans lack health insurance. More organizations are addressing this issue.

“While many show a strong inclination to provide charitable care, more attention needs to be devoted to how we can enable this provision of care in a way that is safe all around – safe for the patient, the provider and the system,” Casey said.

Dr. George Ellis, a physician with Orlando Health Urology in Florida, won the ACS domestic volunteerism award in 2005 for his work as founding chairman of the Primary Care Access Network -- a consortium of local government agencies, community health centers, hospitals, and several nonprofits and faith-based human service agencies in Orange County, Florida.

At PCAN’s 1999 inception, 175,000 people in Orange County were without health insurance. Through PCAN, Ellis established a solid framework for providing access to medical care services for uninsured patients locally.

“Fast forward a few years, we have seen over 100,000 patients use PCAN,” said Ellis. “In the first two years, we realized there were fewer self-paid emergency room visits at hospitals, which meant the PCAN clinics we created were serving their purpose.”

Unfortunately, the number of patients with no insurance has grown because fewer employers are offering insurance coverage, Ellis noted.

According to Casey, volunteering medical care in the United States comes down to three overarching themes: logistics, liability and licensing.

“Even if one individual says they’ll waive fees for a patient — which happens frequently — the patient may still encounter barriers through an O.R. charge, or radiology or lab charges,” she said.

Despite existing Good Samaritan laws and various provisions for charitable care across America, each state is different; so individual providers may feel differently about their ability or protection from a liability standpoint, Casey added. Ongoing efforts to coordinate care on both an individual and a systems level are needed.

“Many doctors are now afraid that if they volunteer their time, they will then get sued,” said Ellis. “Liability reform might promote more volunteerism; and some of our economic woes might get resolved with more volunteerism.”

But even with these risks, free clinics are popping up across the nation. In L.A. County, where nearly 2 million are uninsured, CareNowUSA -- a nonprofit charity -- hosted a free medical, vision and dental clinic for 4,000 patients, with nearly 850 health care providers volunteering their services at the Los Angeles Memorial Sports Arena in October.

“We’ve all read about the millions of uninsured,” said Don Manelli, president of CareNow USA. “Events like this put a face on the numbers. Until you see them in one building at one time, you really have no idea how bad it is.”

Based on the success of the L.A. event, Manelli said he has plans to expand the event to other states next year.

Dr. Natalie Nevins, whom volunteered as medical director at the event, said CareNowUSA’s efforts are important, but the ultimate goal is to be obsolete.

“We need a health care system that cares for all the people who live here, that does primary care in a way that is thoughtful and preventative so we aren’t dealing with advanced diseases because no one has had the time to educate the patients,” she said. “We have to start frontloading -- spending money and time on the frontend to not have it be expensive and time consuming on the backend.”