The donation of no-longer-needed equipment and supplies can appear as a win-win solution, but like other sustainability initiatives, a scratch on the surface may reveal a brown color underneath a green veneer.

On a recent trip to Haiti, Bruce Compton, senior outreach coordinator for the Catholic Health Association, found that three of the four hospitals he visited had X-ray equipment sitting unused in the waiting room. The unused equipment would not benefit any patient—not then, not ever. The equipment had been donated by well-intentioned healthcare facilities in the United States.  The best of intentions can result in harm—toxic materials, excessive waste, and potential exposure to the community, not to mention a lot of manpower to get it from the donating hospital to the recipient.

Catholic Health Association’s April 2011 study “CHA Medical Surplus Donation Study: How Effective Surplus Donation Can Relieve Human Suffering” highlights the harsh reality that the majority of donated equipment and supplies go unused. The grant-funded report explains the complexity of the issue and calls for a closer look and action around responsible donation to ensure safety, environmental benefit, and value to all parties. This is the first step in identifying a solution so that best intentions result in successful donation and reuse.

 

Hospital perspective

Hospitals, long-term care facilities, private practices, and manufacturers can be excellent sources of equipment and supplies, usually due to upgrades, renovations, and moves. Equipment donation appears to help hospitals do the right thing, improve environmental impact, and avoid hefty waste fees. Many hospitals have set lofty recycling and diversion goals, and strive for top honors through award programs like Practice Greenhealth’s Environmental Excellence Awards.

Achieving high recycling rates may look good on a sustainability report or award application, but responsible donors have done due diligence and taken a hard look at their equipment, supplies, and internal process. They have a written assessment protocol, staff training, and documentation to support and track donation with an experienced medical supply and recovery organization (MSRO). These facilities have leadership support and understanding that donation of equipment is a community benefit and mission demonstration. If its value is cost savings alone, then those driving the work may donate broken, expired, or outdated equipment—good for the bottom line as well as for recycling and diversion rates, but bad for the environment and not helpful to those in need of quality product.

Sixty percent of the hospitals surveyed in CHA’s study reported donating broken equipment.

 

Planning ahead

Responsible MSROs can be identified by working with group purchasing organizations and Practice Greenhealth, through guidance from Health Care Without Harm’s international work, the Green Guide for Health Care, and detailed documentation in a request for proposal. The Green Guide’s self-certified toolkit gives guidance on environmentally preferable purchasing to avoid toxic chemicals, partnerships for manufacture take-back programs, packaging prevention, and energy efficiency.

The document helps set a process for deconstruction, that is, conducting a walk-through of spaces before they undergo renovation to recover, reuse, redeploy, donate, or recycle materials, equipment, and supplies. The GGHC waste management section guides development of a waste plan and responsible donation or recycling for all material types. Virtual bulletin boards and increased communication can help sustainability teams identify surplus equipment before it ends up in the trash yard. The alternate, transporting equipment to a warehouse or storage room, often results in a waste of real estate.

 

Choose partners wisely 

Whether reused or no longer needed, all scenarios require responsible partners, that is, responsible MSRO partners for donation or responsible recycling and disposal vendors. The donating organization is ultimately responsible for materials and wastes. Unless no-longer-needed equipment is successfully redeployed and put to use, it cannot count towards an organization’s recycling or diversion rate. If an item is assessed and deemed a waste item that cannot be repaired for redeployment, it could be managed as an electronic recycling/waste material, as with our fastest-growing waste stream of computers, printers, copiers, cell phones, and other electronic  equipment.

Through organizations like the Basel Action Network, waste generators can learn more about “toxic trade” and identify responsible recyclers through their e-steward program, or the R2/RIOS certification for responsible recycling of electronics wastes, where recyclers adhere to strict environmental and human health standards.

Partnering with an experienced organization can ensure intention and reality are one and the same. Catholic Health Association is developing a checklist to help organizations assess their MSRO business partners to make sure they choose the right provider. Charitable organizations, like MedShare , have learned, by doing, to carefully evaluate products and equipment, and ensure there is a need before sending supplies and equipment. A.B. Short, CEO and founder of MedShare explains, “The higher-tech the equipment, the less likely we are to be successful. It is extremely important to evaluate the usefulness of the equipment we send within the context in which it is being used and to ensure that the infrastructure is present to sustain it.”

MedShare has worked with partnering organizations to host trainings on equipment maintenance, repair, and troubleshooting. Its senior biomedical engineer, Eben Amstrong, travels to recipient countries multiple times a year, often at the invitation of the Ministry of Health, to host biomedical training sessions. He works with local doctors, nurses, hospital staff, and technicians and teaches them basic skills to repair and operate biomedical equipment. In fiscal year 2011 alone, Armstrong traveled to Zimbabwe, Tanzania, Swaziland, Haiti, and Ghana.

Another MSRO, IMEC (Improving Health Care for the World’s Poor) has found its success through the development of a suite of offerings. The group has identified more than 40 room types and developed standardized equipment needs for each room type, including maternal, emergency, nursery, radiology, and administrative offices. For example, an exam room would require an exam table, couch, a mercury-free blood pressure device, scale, medication cart, and gooseneck lamp.

IMEC accepts quality donations that meet the needs of the suite of offerings. If a donation is not identified on its needs list, it will not take the item or equipment. IMEC only sends complete standardized suites, and each suite always has the same items. Tom Keefe, founder and president of IMEC, explains, “Thorough assessment of both the receiving facility to determine which equipment is appropriate and the donated equipment to make sure it is suitable for the developing world, are essential to a successful project.”

After the earthquake devastation in Haiti, Partners in Health went to IMEC regarding the construction of a 300-bed facility in Mirebalais that included 30 exam rooms, four treatment rooms, five assessment rooms, and six operating rooms. This project had been underway for more than two years when the earthquake hit, and after the quake, its need was accelerated. IMEC and Partners in Health reviewed the blueprints to see if the approach IMEC uses would work with equipping a new hospital.

 

Research

University of Michigan’s Cardiovascular Center, a Practice Greenhealth Environmental Leadership Award Winner, released a study in which it researched the safety and efficacy of reused pacemakers (which had been removed for burial or cremation) for recipients in Third World countries that otherwise would not have been able to afford treatment. Growing evidence and support led to Project My Heart Your Heart, a collaborative among citizens, physicians, and funeral directors of Michigan, the University of Michigan Cardiovascular Center, and World Medical Relief Inc., a Detroit-based nonprofit organization that specializes in the delivery of used medical equipment.

We are all connected to the unused X-ray equipment sitting in a waiting room in Haiti. And we’re all committed to quality supplies that are sent to thankful beneficiaries. The sustainability community, its variety of players, can make the change so that a scratch on the surface reveals a deeper shade of green. HCD

Identifying a medical supply and recovery organization checklist

Does it …

❑ Have experience?

❑ Assess pieces of equipment to identify which are of benefit and which should be recycled?

❑ Assess the needs of the recipient before sending supplies and equipment?

❑ Assess, repair, and ensure all donated equipment is in good working order?

❑ Have a biomedical engineer on staff?

❑ Visit the recipients of the supplies?

❑ Provide training on equipment use and maintenance?

❑ Ensure the operating manual is accompanying the product?

Donor tips and internal checklist

❑ Ensure there is a need for the equipment.

❑ Save operating manuals.

❑ Purchase quality equipment and properly maintain it to extend its life.

❑ Seek chemical disclosure when purchasing any electronic equipment.

❑ Assess equipment to ensure its functionality.

❑ Ensure equipment i
s fewer than 10 years old.

❑ Ensure it is mercury-free.

❑ Ensure commonly needed spare parts are available.

Resources

•       Catholic Health Association’s “Medical Surplus Donation Study: How Effective Surplus Donation Can Relieve Human Suffering” – http://chausa.org/International_Outreach_Overview.aspx

•       The Story of Stuff Project’s “Story of Electronics” – http://storyofstuff.org/electronics/

•       Practice Greenhealth’s Environmental Excellence Awards – http://practicegreenhealth.org/awards

•       Health Care without Harm’s International Work – http://noharm.org/global/

•       The Green Guide for Health Care – www.gghc.org

•       Basel Action Network – www.ban.org

•       R2/RIOS Certified Electronic Recyclers – http://www.certifiedelectronicsrecycler.com/

•       Project Your Heart My Heart – http://www.med.umich.edu/myheartyourheart/index.htm

•       MedShare – www.medshare.org

•       IMEC  (Improving Health Care for the World’s Poor) – www.imecamerica.org