In the most desperate developing countries in the world, children and adults suffer and die every day because their physicians, hospitals and clinics — if they exist — lack the necessary supplies and equipment to treat them. According to the World Health Organization, more than 10 million children younger than age 5 die in these countries each year due to inadequate medical care. Potentially life-saving surgeries are cancelled because there are no sutures. Hospitals are overcrowded; patients often lie three to a bed. Physicians wash, patch and reuse exam gloves — or they use plastic bags as exam gloves — to protect themselves from diseases such as AIDS.

At the same time, U.S. hospitals discard an estimated $6.5 billion of medical supplies and equipment each year. Every day, tons of medical waste are dumped into landfills — 85 percent of which is nonhazardous, nonbiological solid waste. These supplies are discarded because of technological change, regulatory requirements, production overages and procedural excess. Much of the waste is still viable.

MedShare's Focus and Accomplishments

Since 1998, MedShare, a nonprofit organization, has been recovering surplus medical supplies, instruments and equipment and redistributing them to hospitals and clinics in medically underserved communities — not only supplying developing countries, but also reducing landfill in the U.S. By collecting a weekly average of 10 tons of surplus material from hospitals, manufacturers and distributors, MedShare has diverted more than 2 million cubic feet from our community landfills.

During this period, more than 750 shipments, each containing five to six tons of material, have been sent to 93 countries, including more than 150 tons to Haiti after its devastating earthquake; most recently, MedShare delivered 10 shipments to help rebuild hospitals in Libya. In addition, more than 2,500 medical mission teams have obtained provisions for their work around the globe. Qualified hospitals and clinics use MedShare's Web-based ordering system to select the exact supplies needed from MedShare's inventory of about 10,000 items. Distribution and volunteer centers, each with approximately 50,000 square feet, are located in Decatur, Ga., and San Leandro, Calif.

MedShare also provides biomedical engineering assistance. The WHO has reported that 40 to 60 percent of medical equipment leaving the United States for developing nations either doesn't work or is not appropriate for the recipient facility; others have indicated the figure may be as high as 75 percent. Consequently, MedShare has built a state-of-the-art biomedical program to ensure that the equipment it sends can be put to use. MedShare's biomedical engineers evaluate, test and repair equipment prior to shipment and provide assistance both remotely and on-site.

Financial donations from individuals, corporate gifts and grants, as well as in-kind support and services from national and global companies, are MedShare's only sources of assistance, with one significant exception: the contribution of 15,000 community volunteers who now devote 45,000 hours annually to sorting the surplus medical supplies. Due to all of these factors driving efficiency and effectiveness, Charity Navigator ranks MedShare as a four-star charity with 96 percent of its revenues directly related to program activity. As a Lean organization, MedShare is able to transform every $1 in direct donations into shipping $7 in life-saving aid to the medically underserved around the globe.

Significant Domestic Benefits

While the majority of material is shipped to hospitals in countries throughout the developing world, MedShare also supports safety-net clinics and underserved communities in the United States. Many of our own citizens rely on free clinics for health care, usually because they are unemployed or have jobs that don't provide health insurance. Through MedShare's medical team store program, free and safety-net clinic staff can visit its distribution centers and select supplies, thus reducing its operating costs and providing more care to the medically underserved in our communities.

Emory University's Nell Hodgson Woodruff School of Nursing's Georgia Farm Worker Family Health Program exemplifies what can be achieved through creative partnerships. For the past 16 years, this program has provided free health care to more than 100,000 migrant and seasonal farm workers in southern Georgia. These workers face more complex health issues than the general population because of the physical demands of their jobs, pesticide exposure, poor access to health care services and substandard housing conditions.

Emory nursing volunteers spend two weeks in June each year examining children by day and setting up mobile clinics to treat adult farm workers in the evening, often providing the only health care these workers and their family members receive the entire year. MedShare provides many of the supplies the nursing volunteers use to care for the workers.

As another example, MedShare provisions the Remote Area Medical clinics in California each year. Since 1992, this nonprofit volunteer corps dedicated to providing free health care, dental care and eye care services has treated thousands of low-income, uninsured patients.

In addition to supporting free clinic work, MedShare has responded to domestic natural disasters, such as Hurricane Katrina and the recent tornados in Alabama. In Alabama, MedShare used relationships with product manufacturers to send two tractor-trailer loads of supplies to the Alabama Association of Volunteer Fire Departments. These volunteers are often the first responders with paramedic services and first aid in rural areas, but the tornados destroyed many of their facilities. The urgent humanitarian need rapidly depleted their existing supplies. MedShare aid helped them get back on their feet and meet the needs of Alabama citizens.

An Opportunity for Health Care Leaders

Plans are well under way for MedShare to expand its operations to southern Florida and to New York state. Other areas of the country also have expressed interest in MedShare's program. In addition, a few years ago, when MedShare and several other medical surplus recovery organizations convened the first national meeting of groups engaged in similar activity, representatives from 16 other organizations attended.

Although MedShare and other medical surplus recovery organizations vary widely in size and scope, they have a genuine interest in sharing best practices. Among the lessons MedShare has learned to date are to:

  • conduct an extensive review to assess whether comparable organizations exist that may be receptive to collaboration;
  • identify, educate and recruit community and hospital leaders to serve as passionate champions;
  • determine when and how sufficient funds can be raised to support each program;
  • achieve financial sustainability through a combination of partnerships, container sponsorships, major gifts, multiyear grants and individual donations;
  • establish well-defined organizational performance indicators and metrics;
  • ship only what the recipient wants and can use;
  • target shipment recipients in selected areas for whom repeat shipments will have a major impact on their ability to achieve sustainable improvements in health care;
  • appraise the logistical hurdles, including customs and other governmental issues, well in advance of preparing any shipments;
  • require completion of evaluation questionnaires by recipients to obtain their feedback on the value of the material and its impact on their services;
  • develop strong and lasting partnerships with U.S. health care systems and global corporations;
  • avoid underestimating the time and resources required to create and maintain a viable organization.

The huge gap between surplus and need probably will never be filled. MedShare's ultimate vision is that its model will enable effective and efficient reclaiming and redistribution of nearly all usable surplus medical supplies, instruments and equipment in the United States — both through its own efforts and through influencing best practices among similar organizations. Much more work can and must be done.

Paul B. Hofmann, Dr.P.H., F.A.C.H.E., is a member of MedShare's board and executive committee and president of the Hofmann Healthcare Group in Moraga, Calif.