MedShare abroad: Top 5 Takeaways from Guatemala Trip

Thanks to all who have shared feedback and ideas based on my blog posts about our recent site visits in Guatemala.  Over the past week, I have debriefed with our U.S. based MedShare team, and we have worked to solidify action steps and lessons learned.  We have already started putting the knowledge gained into action!

Following are my top 5 personal “takeaways” from this trip to Guatemala.

1. Partnerships are key.  We’ve said it before and we’ll say it again.  There’s no way to do this work in a high-quality way without deep partnerships.  The “flavor” of the partner (NGO, hospital, corporate, foundation) is much less important than having a shared philosophy of respect for the recipient and a focus on impact and sustainability.

2. More biomedical training & repair trips are needed.  The training and repair trips are extremely high impact and provide sustainable health system improvements.  Eben provided 20 Guatemalan technicians, nurse and doctors from 6 different hospitals with training. As a result, they will be able to better maintain and repair their hospitals’ key medical equipment for years to come.  MedShare must do more of this work.

3. People are amazing.   The generosity, passion and hospitality of people around the world truly takes your breath away.   99.99% of people you meet want to help and want to make things better and will go to great lengths – including some personal sacrifice – to do so.

4. Mistakes happen.  Sometimes supplies don’t get where we want them to go as fast as we would like.  Perfection isn’t possible in international aid. However, we must always strive for “better” and learn from those times when things don’t go as planned.  Throwing our hands up in despair is not an option.

5. The need is great and we must continue to find creative ways to do more with our U.S. surplus. Every hospital and clinic we visited in Guatemala was doing their absolute best to provide high-quality care for patients and the reality is that none of them had sufficient supplies or equipment to do so.  At the same time, I was seeing this tremendous need first-hand, thousands of pounds of medical surplus were being disposed of here in the U.S.  We must continue to stay focused on bridging that gap between surplus and need.

So, that’s a “wrap” on this productive visit to Guatemala.  In the coming weeks, I’m headed to Florida and New York to advance our expansion work in those important markets.  Stay tuned for updates on how things are going!

Thank you for your continued support of MedShare.  You’re making a world of difference!

Meridith

MedShare abroad: No Poker Face

So, I have been told by many people over the years that I do not have a very good “poker face”… meaning that I convey my emotions clearly on my face pretty much at all times.
Well, during last Friday’s final site visit in Guatemala, my “no poker face” expression certainly showed a mixture of frustration, disbelief and sadness.  Eben and I found almost 75% of the boxes from a shipment that arrived in Guatemala in November 2011 sitting in a warehouse gathering dust rather than being put to good use in the hospital that ordered them.
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Over the course of several hours, we determined that while certainly no one was trying to cause harm or be malicious, there had been a serious breakdown in the on-the-ground distribution process.
Given the significant health care resource needs we saw first-hand in prior days’ visits, I struggled to control my outrage that life-saving supplies had been sitting idle for over 8 months.  After several attempts at settling myself with deep, yoga-like breathing and working to assemble at least some version of a neutral expression, I worked with our in-country partners to figure out an efficient plan to quickly get the supplies distributed where they can be used.  We also started the analysis of what went wrong so that we can learn from this mess and avoid similar issues in the future.
While I certainly hadn’t planned on having my last day of this visit in Guatemala be such a troubling one, I am extremely grateful that we discovered the problem.  Otherwise, those supplies could have been gathering dust in the warehouse indefinitely.  Also, these types of “uggghhh” moments can certainly keep an organization humble and make sure we respect the complexity of the work we do.  Distributing U.S. medical surplus to developing countries is easy to explain in a casual converation, but extremely difficult to actually do in a high-quality, efficient manner.  We routinely do a good job at MedShare but we certainly aren’t perfect.
At the end of the day, I may be a dreadful poker player, but I do have the confidence that we can fix this problem and continue to do even better in the future.
Thanks for reading!
Meridith

MedShare abroad: Riding the roller coaster of humanitarian aid

I love surprises.  I don’t ever want anyone to tell me how a movie ends before I see it myself.  I beg my boys not to spill the beans on my birthday present before I can open it.  (Despite my pleading, they usually can’t help themselves and tell me anyway.)So, when the team from Food for the Poor said they had a “surprise” for Eben and I when we arrived at the National Hospital of Antigua, I was excited and intrigued.  I literally jumped for joy when they told me that a shipment of supplies sent recently from MedShare’s Western Region had arrived earlier than expected and was unloaded at the hospital just yesterday.  It was like all my favorite holidays combined into one brilliant moment!  We were definitely flying high on the international aid roller coaster and feeling quite proud… we could see directly that our work really does make a difference.

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ImageAs a result of this fortuitous timing, Eben was able to provide real-time training for technicians, nurses and doctors on the equipment sent including a defibrillator, infant incubator and hospital bed.  In fact, when we went to check on one of the hospital beds shipped, we learned that the bed – which had literally arrived just yesterday – was already being used by a woman in labor.  Talk about meeting an urgent need!

After flying high in the morning, I found myself crashing down the humanitarian aid roller coaster in the afternoon.  We visited Hospital de Chimaltenango, a 160-bed hospital that is operating under what the doctors themselves describe as a “crisis.”  To add to an already overwhelmingly bleak situation, two weeks ago the hospital had a fire in its pediatric unit that was caused by a rigged-up phototherapy mechanism (they do not have standard bilirubin lights used for jaundiced infants).  Luckily no one was hurt, but an already resource-poor facility now has to deal with restocking an entire unit.

After choking back tears for most of the tour, I finally broke down and wept as Dr. Castillo, head of Pediatrics, showed us her intensive care unit which consists of only two cots and a nebulizer.

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She has no monitors or ventilators and yet, she comes in every day and provides the best care she can just as the rest of the doctors and nurses and staff do.
I smiled and wiped away my tears when I saw Dr. Castillo coo with delight as she checked on Baby Norma, one of her youngest and smallest patients.
ImageI thought about the entire MedShare family – our amazing volunteers, generous donors, dedicated partners, and fiercely committed staff, Board and Council members. Together, we can help Dr. Castillo, Baby Norma, health care professionals and – most important – patients all across the world.  We have the surplus; they have the need. So, let’s get to it and keep riding that roller coaster.  After all, you never know what kind on inspiring surprises might be just around  the corner.

MedShare abroad: Like an artist without a paintbrush…

Today I met two extraordinary men working at the Centro de Salud (government health clinic) in Panajachel.  Dr. Marlon Monroy is the Director of the clinic and Dr. Juan José Barrios is the clinic’s dentist.  They are skilled medical professionals with a passion for caring for the local population of almost 40,000.  About 40 patients per day come to this clinic which is open 24 hours a day. However, there is a huge problem.  The clinic does not consistently have the supplies and equipment needed to care for the 1,200 patients per month.
I equate this dreadful situation to that of asking a talented artist to create a work of art… but providing no canvas, paints or brushes. It’s an impossible task. Likewise, doctors, dentists and nurses simply can’t adequately care for their patients – no matter how talented they are – without the right tools.  The consequences are severe and can in some cases mean the difference between life or death.
At the Centro de Salud, the shelves in the bodega (central supply room) were pretty bare.  Dr. Monroy reported that often the nurses have to ask patients to buy their own supplies (for example, gauze, gloves, syringes) from the local pharmacy.
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Exam rooms have only the most basic equipment.
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In the marernity area, Dr. Monroy has a very difficult situation because there is no easy access to toilets for women in labor or post-partum.  Complications and deaths related to childbirth are a critical issue in Guatemala, and the staff agrees that the maternity ward at Centro de Salud Panajachel lacks sufficient infrastructure, equipment and supplies to truly provide acceptable quality.Image

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For the dental clinic, Dr. Barrios reports that he is only able to do extractions and can do no preventive cleanings or fillings because robbers stole most of his equipment over the past year.
So, what to do?  Honestly, my first instinct is to cover my eyes in despair and weep when I see a situation like this and then think of similar clinics and hospitals all across the developing world.  The tremendous need is overwhelming and sits so heavy on my heart.
But then, I take a deep breath and try to figure out how the MedShare team or one of our amazing partners can help.  Can we find a sponsor for another shipment to this area that could include supplies and equipment for this particular Centro de Salud?  Is there a dentist that’s a “friend of MedShare” who might be interested in volunteering at this clinic with Dr. Barrios and bringing down some basic dental equipment?  Just like an artist and her paintbrush, these doctors need the right supplies and equipment.  How can we help them?
There are no easy answers and no happy ending to my story today. As I left the clinic, I promised to the doctors and nurses to see what I could do and thanked them over and over and over for their dedication to caring for their patients under very challenging circumstances.
Thank you to all of our generous MedShare supporters who make it possible for us to provide “paint brushes” to talented medical “artists” all over the world.  I hope that we can find a way to help our friends at Centro de Salud Panajachel in the very near future.
Thanks for reading,
Meridith

MedShare abroad: Sharing is a good thing! A real-time example of when the MedShare distribution model works

As the mother of three young boys, I find that I am often engaged in discussion (sometimes rather heated) about the importance of sharing. It doesn’t matter if it’s Skittles candy, Legos, or a favorite T-shirt, the reality is that often it’s hard to share something that you would prefer to use or consume yourself.  And yet, as MedShare co-founder A.B. Short says, there really is usually enough to go around.  This is the whole basis for the MedShare model:  getting U.S. medical surplus to the places where it is most needed around the world.
Like most developing countries, the health care delivery system here in Guatemala is a combination of national, government funded facilities alongside private hospital and clinics.  MedShare works with any facility as long as they serve the most needy patients in their area and have the capacity to use the type of supplies and equipment we can provide.
Our shipments come in 40-foot containers filled with approximately 1,000 boxes of consumable supplies (gloves, gauze, syringes, etc.) and 20 or so pieces of equipment.  While a full-scale hospital can easily use the full contents of a container, a smaller clinic just doesn’t need that volume of supplies.  And yet, those clinics are often the places with the most need for supplies.  So, what to do?
Well, sometimes, the MedShare team is able to find just the right partners on the ground who help us weave together a wonderful distribution of supplies to a region. In other words, they share!  I have been lucky enough to see this system in action here in Guatemala over the past two days.
Hospitalito Atitlán is a private, 16 bed hospital that sees about 800 outpatients a month with 200 monthly ER visits. They are open 24/7 with a full emergency room and two operating rooms.  They have both Guatemalan and American doctors on staff and provide training to local midwives and are building a diabetes education program along with several other local organizations.  Hospitalito is providing high-quality, low or no-cost care, and so, the supplies that MedShare can provide allow them to care for more patients and extend their services.
When MedShare shipped a container to this hospital earlier in 2012, the staff could have easily decided to keep all of the supplies for use at the hospital. But they didn’t. Instead they contacted the medical staff of several surrounding government and private hospitals and clinics and guess what?  They shared about 40% of the shipment.  And that’s a wonderful thing.
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Over the past two days, I have visited several of the sites that benefited from this sharing including Santiago Centro de Salud and the National Hospital of Sololá.
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While I have received many hugs of thanks and enthusiastic exclamations of “muchas gracias” from these additional recipients, the credit really goes to the leadership of Hospitalito Atitlán for having the vision, the compassion and the willingness to do the hard work involved in sharing.  Well done!  I think their mothers would be very proud, don’t you?
Til tomorrow,
M

MedShare abroad: Meridith travels with Director of Biomedical Engineering, Eben Amstrong

During this MedShare visit in Guatemala, I am delighted that our talented Director of Biomedical Engineering and Technical Services, Eben Amstrong, is doing training and repair sessions here in Santiago Atitlán and also in Antigua and Guatemala City.

We know from years of experience (and as reported by the World Health Organization) that building biomedical equipment repair and maintenance capacity in-country is a critical part of strengthening health systems.  MedShare is very grateful for the support of the Mundito Foundation in funding this important training and repair session trip. This type of capacity-building investment yields enormous returns for the community and enhances sustainability of MedShare’s work.  In straight-up business terms, the ROI is significant which – in our line of work – equates to more lives saved.

Eben and I were warmly welcomed this morning by the staff of Hospitalito Atitlán, and three days of intensive, hands-on training is underway for a lively group of 10 electricians, nurses, doctors and other hospital staff.  The group comes from three different hospitals/clinics. As there is not a biomedical training program in Guatemala, Eben is providing vitally needed training to build the skills of this dedicated group to maintain, repair and use key pieces of biomedical equipment.  Without this in-country capacity, equipment inevitably ends up in the corner of a hospital gathering dust….and potentially life-saving resources sit idle. Here at MedShare, we detest dusty equipment.  Dusty equipment represents good intentions with insufficient implementation.  Ugggghhhh!

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Luckily, Eben is truly a master trainer, and it has been wonderful to see the confidence and skills of the trainees grow after just one day. As an added bonus, the host hospital gets lots of free equipment repairs.  For example, an ultrasound that had not been working for quite awhile was repaired by a simple cleaning of a key component. The staff now knows how to perform this maintenance cleaning once per month to keep the equipment in working order.  This picture shows one of the trainees explaining what he has learned about the steps required to fix this problem should it reoccur.

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 Later today, a dedicated group of trainees decided to stay late and work with Eben on additional equipment repairs.  Shown here, Eben is explaining to the group how to diagnose a common problem with an electronic insufflator (a piece of equipment used to push air into the bowels during an endoscopic procedure).  A very common challenge with this equipment is that the tubing gets brittle and detaches.  It is simple and inexpensive to fix, but unless you know what to look for, the equipment is often declared “broken” (and likely to gather dust or become a door-stop). Henry, a local electrician that works at Hospitalito Atitlán, said at the end of the day, “One day of training with Eben is like reading 10 books.”

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 In the coming years, MedShare plans to grow our Biomedical Training and Technical Support program.  In order to expand, we must secure additional high-quality equipment donations from hospitals, clinics and manufacturers across the U.S. and also find funders seeking a high “social return” on their financial investment. If you are interested in supporting our Biomed Program or have ideas on how we can expand our impact, please contact MedShare’s Chief Operating Officer, Charles Redding at credding@medshare.org.

Until next time,

M

MedShare abroad: CEO Meridith Rentz checks in from Guatemala

Holá from Santiago Atitlán, Guatemala!

Over the next few days, I am visiting hospitals and clinics in Guatemala and meeting with local MedShare partners and friends. Throughout this trip, we will strengthen existing partnerships, build new relationships, share knowledge and ideas, and, very importantly, learn how we can enhance the impact of MedShare’s work in Guatemala.

MedShare has shipped 32 forty-foot containers to Guatemala since 2000, and we are eager to continue to support the efforts of those working here on the ground to provide health care for the most needy in this country.  Over recent decades, Guatemala has struggled with natural disasters and a devastating civil war; and yet it remains a beautiful country with a vibrant Mayan culture and generous, hard-working people.

MedShare plans to ship approximately 150 forty-foot containers of donated medical supplies and equipment this year to over 35 countries.  In order to maximize the impact of these shipments and be efficient stewards of our financial, supply and equipment donations, it is critical that we continuously improve our programs.  MedShare has a 14 year history of providing very high quality donations AND we know can always do better.  In fact, the MedShare team is a bit obsessed with figuring out how we can improve and innovate!  The best way to do that is by actually seeing, listening to and experiencing the health care realities in the countries we serve.  So, the next week in Guatemala will be packed full of listening, learning and planning for the future.  Stay tuned for daily reports from the road.  If you have questions, ideas or suggestions, send them to me via Twitter @mrentz or via email at mrentz@medshare.org.

In service,

Meridith Rentz, CEO, MedShare

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