Medical Aid Abroad New Zealand A review of an international aid organization Dr Graeme Woodfield

Transcription

1 Medical Aid Abroad New Zealand A review of an international aid organization Dr Graeme Woodfield Introduction Many developing countries have problems with meeting the health needs of their populations. Financial restrictions often mean that the health services are minimally funded and people are required to depend on their own resources. There is often a reliance on supporting agencies to carry out a proportion of health services. Charitable organizations commonly fill gaps in the health services and in some countries, carry the load of meeting an important proportion of the health needs of the general population. Not uncommonly, these organizations raise funds in developed countries to meet some of the needs of their activities and there is often a high input from Church based or Interdenominational groups. Their role is often greatly valued by the recipient country although not always widely recognised. The number of voluntary organizations that have activities in providing health care in overseas countries is extensive. Although there are often criticisms of Western societies for not always sharing their wealth, there are still very considerable efforts being made by some sectors of these populations to meet overseas health needs. The list of organizations that can provide assistance is very long but many countries are poorly informed of the help that can be made available. Electronic communications may soon mean that many countries will be able to access specific data that will be helpful in various areas of their health needs. The following is a review of one low-key community based voluntary health organization, which over a period of 30 years has been able to provide substantial assistance to developing countries. The organization Medical Aid Abroad New Zealand (MAANZ) is an organization that is small but effective in the work it carries out. Its main aim is to provide pharmaceuticals and medical and dental equipment for developing countries as well as engaging in other related activities such as health personnel training. It has been functioning since 1967, and is supported by a variety of voluntary, medical and pharmaceutical established organizations. It is a voluntary and charitable society, depending entirely on the input of many motivated people and operates on a very low budget provided by its members. It was founded in 1966 by a group of doctors, pharmacists and lay persons in Christchurch. Over the years, other branches developed in Dunedin, Wellington and Auckland (1). It is an incorporated society with Rules of Association which have recently been re-formulated to meet present needs and the name changed from MAA to MAANZ. A list of MAANZ supporting organizations is noted in Table 1.

2 Medical Aid Abroad New Zealand 2 TABLE 1: Supporting organizations for MAANZ NZ Medical Association NZ Dental Association Pharmaceutical Society NZ Red Cross Society (Inc) Volunteer Service Abroad World Vision NZ National Council of Churches Order of St Lazarus Catholic Church Council for Mission Mode of operation. Incoming supplies Drugs and equipment comes from individual pharmacies and hospitals that MAANZ has had contact. Pharmaceutical manufacturers and wholesalers have not uncommonly donated large quantities of goods while equipment comes from a variety of sources such as hospital salvage stores, ex-government stocks, redundant hospitals and individuals. A system has evolved in Auckland whereby Community Laboratory couriers deliver goods to a central collecting area for later transport to the main storage area. For many years, MAA accepted drugs for recycling that were past their expiry date. It is well known that the vast majority of drugs are still therapeutically active for a considerable period after the printed expiry rate although there may be a slight loss of potency. On this basis drugs were recycled and often pooled, then relabelled in new containers. Present policy is now to only accept in-date drugs for distribution. There are several reasons for this change of policy. Firstly, some developing countries do not allow the importation of outdated drugs because of quality concerns. Secondly, the World Health Organization has issued guidelines that discourage the donation of expired drugs to Third World countries. These guidelines were issued in response to the dumping of huge quantities of unsolicited and often inappropriate medical supplies by some agencies in areas of humanitarian crisis (2). MAANZ has a conservative attitude and ensures that all drugs released for issue have been checked by pharmacists and are in date. Exceptions only occur when local health staff assures MAANZ that the drugs will be stored and used appropriately and rapidly and this requires personal liaison with the Doctor in charge of the hospital or health centre. A wide variety of medical surgical dental and laboratory equipment is handled and this comes from many sources. MAANZ cannot normally refurbish equipment although at times this has been done on special request. At times, large items of equipment that are redundant have been located such as renal dialysis machines, X- Ray equipment, hospital beds and operating tables. There is still considerable potential for recycling of equipment from hospitals although there are logistic difficulties in handling and storing all that is offered.

3 Medical Aid Abroad New Zealand 3 Sorting of incoming Goods Volunteers, usually pharmacists, doctors and dentists perform this. This is a time consuming activity, usually performed in the evenings. There is a high discard rate of incoming goods, which results in problems of disposal. Goods are placed in designated shelves in the storeroom and the stores are regularly checked to ensure that over dated drugs are removed. Packing of Incoming Orders Volunteers pack these. Special request forms help to define what is needed and where goods are not available, the order is filled with the nearest drug equivalent. There is a high turnover of goods and not all orders can be fully met. There is a high demand for antibiotics, skin, eye and ear preparations, as well as drugs for the treatment of tropical disorders. Bandages, dressings and other similar goods are always in short supply and are seldom in the store rooms for long. Once packed the goods are ready for collection or delivery to a specified location. Wherever possible the recipient organization is asked to pay the costs of transport of the goods although at times MAANZ does assist with this. There are usually sponsoring organizations that are available and many requesters are able to make suitable arrangements. At other times use is made of the Air Force or Navy to facilitate delivery while on other occasions airmail post is used. It has been increasingly common for persons working in third World countries to visit the MAANZ storerooms and select their own requirements and then arrange the transport of the goods. At other times MAANZ has worked with Government organizations to facilitate the delivery of goods and this has resulted in some very large deliveries to be made eg container loads to Vietnam. Orders packed and delivered over the last 4 years are listed in Table 2. Table 2: Orders processed by MAANZ over the past 4 years Orders processed Areas orders sent Pacific* (%) Asia (%) Africa, India (%) Others (%) *PNG (incl.bouganville) Solomon Islands, Cook Islands, Tonga, Nuie Vietnam, Cambodia, Mongolia, East Timor, Philippines b Somalia, Mozambique, India Others includes Azerbaijan, VOSO and Mercy Ships Rooms One of the biggest problems for MAA is the availability of low cost rooms for the activities of the organization. The present rooms are inadequate for all that is done and

4 Medical Aid Abroad New Zealand 4 MAA is actively exploring other options. Ideally, MAA needs to find storerooms in close conjunction with some other charitable organization that has related aims. Feedback All orders include a feed back form inviting information on a variety of matters including suitability of transport, appropriateness of the goods, and other comments. This has helped to provide a good service and the evidence of this are the large number of grateful comments MAANZ receives. Administration The MAANZ executive meets bimonthly and holds an Annual General Meeting. All positions are voluntary and most members have had experience in developing countries. The time is coming when a part-time paid position may be required to ensure that all the activities are maintained to a high standard. Other activities. MAANZ has occasionally sponsored overseas health staff to New Zealand for training. In the past it has a provided lists of paid and unpaid positions available for New Zealand health workers in developing countries. MAANZ also sponsored a visit to Vietnam by a medical team and plans to carry out other such activities in the future. Sponsorship of medical student on an elective project in the Pacific was a useful project providing helpful information on the effectiveness of the work of MAA. Recently a radiographer from Africa was supported for specialist training in New Zealand. The introduction of a website ( has been a useful innovation, and this provides up to date information on the activities of MAANZ. It also provides a list of links to other websites in other countries and particularly to organizations carrying out similar or related functions. Discussion. MAANZ has now been functioning for over 30 years and during that time has been able to provide relatively large quantities of drugs and equipment to many third world countries and particularly in the Pacific. On average about 60% of goods are delivered to Pacific Island countries with the remainder going to Asia and even further afield. An average of over 40 orders are processed nationally each year going to as many as 20 different countries. Some orders may be very large, such as Container loads although most orders will be for 2-3 boxes of goods. However even a small box can contain a very valuable consignment of goods and is a welcome addition to supplies obtained locally. Some clinics have become almost dependent on the goods we can supply and very large multiple orders have been required. The organization has been able to provide special support in times of emergency. Goods were sent to East Timor, to tsunami victims in Aitape in Papua New Guinea (PNG) and large deliveries have been made to Bougainville in PNG.

5 Medical Aid Abroad New Zealand 5 MAANZ is at present faced with a number of challenges. In particular, accommodation is a major problem that needs to be solved soon. Recruitment of new active members is an ongoing problem although this is a common feature of voluntary organizations particularly in a society where many motivated people are already fully occupied. There are difficulties in always obtaining high quality pharmaceuticals in sufficient quantities to meet requirements. Although we prefer to work with nongovernmental organizations in developing countries there is pressure to provide goods to government agencies and this may require a different approach from the present one. Another problem is that the only active branch of MAA is now in Auckland, as ageing, lack of new volunteers and other factors has resulted in the closure or recess of the other NZ branches. There is a need to reactivate the national organization and to make better use of the large amount of health related goods that are presently discarded from our many hospitals. On the other hand, the members of MAANZ are highly motivated and work hard to meet the evinced needs. The demand for services is growing and with population pressures increasing there will inevitably be even more requests in the future for the services we offer both in emergency and non-emergency situations. MAANZ is planning for this and upgrade its operations and to find new ways to meet the challenges of the future. In particular a major project is underway to provide low cost computer technology to developing countries Summary MAANZ is a little-known charitable voluntary low-key organization committed to providing high quality pharmaceuticals and equipment to developing countries and carrying out a number of other health related activities. The organization works best with nongovernmental groups and has developed an informative web site. It has an enthusiastic and informed core group of participants and has innovative plans for the future. It is a good example of how a small group of people can considerably assist the development of community based hospitals and health centres. References Nicholson G, Woodfield G. Can charitable drugs be a useful form of aid? The New Zealand experience.tropical Doctor 12: Hogerzeil H, Couper M, Gray R Guidelines for drug donations Brit med J (1997) The Author Dr Graeme Woodfield, Chairman. MAANZ Box Auckland 3