(A Presentation given by Donald N. Griffith at the May RxConnexion Health Volunteer Meeting)
INTRODUCTION
By our presence here and by our interests in medical mission, we demonstrate the desire to serve. Christian service is based on the desire to love as we have been loved by the one whose resurrection we celebrated a few weeks ago and through the power of God’s Spirit given at the first Pentecost some 2000 years ago. I ask those of us who send equipment to mission settings to refine our love so that it is effective, sophisticated and shared between equals.
To do that takes time. By that I mean time to know those with whom we work, the settings in which they live, the needs and resources where they work and the context in which they serve. For effective transfer of scientific or any other equipment, we move beyond charity (giving for our purposes) to partnership.
THE PROBLEM
Some years ago, my wife Marilyn and I were in the then Soviet Union, the Ukraine, to be specific to celebrate the 1000th anniversary of the establishment of the Russian Orthodox Church. We had been advised to take little gifts to show care and love. One lovely woman had brought hundreds of little, handmade wooden crosses. They were a beautiful, sentimental gift to those eager to meet the “Americans.” However, each recipient seemed a bit standoffish, even shocked as the crosses were distributed with phrases like “God bless you.” Finally, one of our guides and interpreters said, “You need to know that such crosses are given here to dying people! You are probably offending your hosts, but they are too polite to tell you.”
We have similar problems when we try to send equipment to the developing world. Five years ago, we were undertaking one of the most difficult of tasks in a mission setting—cleaning out a storage area. In a culture of extreme depravation, next to nothing is thrown away. It might have some future use or value or disposal might offend a donor. It took literally days to build the trust of the Haitian nurse in charge of the clinic near Jeremie to let us in and finally to permit us to clean and organize the large room which held both useful items and frankly junk. We cleaned, organized and sorted. We discovered a supply of dental equipment provided by someone, somewhere who included his/her collection of pulled teeth in the shipment. There it was- a box of hundreds of human teeth—none, however had any gold! Such insensitivity probably explains why the vast majority of the instruments were rusted broken, bent and virtually useless. The mission however, had to use needed resources to have them shipped from Port au Prince to Jeremie only to be stored.
In Jamaica, a hospital administrator reported, with more than a little frustration, that he had a basement full of expensive equipment sent by American well-wishers. Unfortunately, they were useless because the electrical current in Jamaica is 110 volts (same as ours) but 50 Hz, not 60 Hz like the US. In Bo, Sierra Leone, at Mercy UM hospital are 6 ultrasound machines, desperately need in this underdeveloped part of the world. Unfortunately, they do not work because the computer software for the probes, (the little scopes that are moved across parts of the body,) was not included. Some $60,000 worth of needed equipment is useless.
Most of you could share other examples of similar experiences of well meaning actions. Dr. Cherian Thomas, who is here for this conference says, “Africa is where old equipment is sent to die.” I add, they are examples of not taking the time for real love.
The basis of the problem is three myths. The first is “They Can Use it.” I’ve found myself loading a container looking at a rusty chair or old computer saying it is better than what they have. I would never accept it. No they can’t use it. Junk is junk. Perhaps equipment can not be used because of voltage differences, maintenance inexperience or lack of technical support or supplies. Only if we are familiar with the setting and need can we know if it is useful.
A second myth is “After all it’s free.” Please recognize all the costs involved. A container to Sierra Leone and probably much of the distant world is about $10 a square foot. That covers the container, transportation expense and customs. In addition, consider the costs of sorting, storing, integration and often disposing of items. That adds a new meaning to “it is more blessed to give than to receive.”
The third myth is “We can’t say no.” When a generous donor wishes to give a piece of equipment, the most natural answer is yes. We don’t want to hurt anyone’s feelings and we have the other two myths whispered in our ears. We may not have the time to find out if it is appropriate. Last summer we sent a physical therapy clinic to Kissy Hospital in Sierra Leone and included a treadmill from a friend. We’d been assured that it worked and was in good condition. Later when we got to Kissy Hospital, we discovered that while it worked, it did not have a dead man’s switch and was in fact dangerous for physical therapy use.
MAKING LOVE REAL
The following are some simple principles that we can use to make the love expressed in the desire to send equipment, real love.
Determine if it is technologically appropriate. Does the receiving site have the infrastructure to support the equipment? We sent an anesthesia machine to Sierra Leone only to learn that medical gasses are no longer available. Know before you ship make certain supplies and support are available. Are personnel trained to use laboratory equipment? Can the surgery use the kind of equipment to be sent, etc? Can and will it be used?
Test it before it is sent. Ask the donor to provide a report from a qualified technician that medical equipment is in good working order and new enough to have repair parts available. It is a good idea to ask the recipient if parts, supplies, and service are available locally. Depending on where it is, service may be available. If not, take into account the cost of sending supplies and replacements.
Determine that equipment is electronically compatible. Most of the world uses a different electrical system than the United States. We need to understand in detail what is available at the receiving site. Many times a technician can turn a simple switch to change a machine rated for110 volts to 220, but donors need to understand the hertz locally. If 110 volt equipment must be sent, it is best to send a properly rated transformer, or better yet, install it on the machine before sending. In developing world sites, transformers are expensive and often underrated and poor quality. Don’t forget to supply the proper electrical plug for the area where it will be used. Sending a good surge protector is also a good idea.
Provide training and follow-up for complex equipment. This may be the most difficult of the principles to follow. It takes time, money and dedication to see that technical equipment is used, maintained and supported. A hospital was given an ultrasound, but none of the staff were trained in its use. A specialist had to be hired to come on Saturdays to see patients and in the day of service was paid more than staff physicians were paid per week. Power difficulties and maintenance problems soon made the expensive piece of equipment unusable. Donors can not take for granted that local staffs have had the training to use gifts offered in love.
All of these principles require a partnership between the donor and the recipient. It is not easy to build the rapport for honest communication about the suitability of equipment and its use and ongoing support. Questions have to be asked and clearly answered about who pays for ongoing supplies and maintenance. When will the recipient begin covering the costs of consumables? How will those using equipment be trained? What happens when equipment no longer works? Will the recipient feel comfortable saying to the donor, “We really can’t use----?” It takes time and energy to love in deed. It isn’t easy, but it surely is rewarding.
WHO CAN HELP
Let’s not forget than an important ally is the recipient of our gift. They can help us, if we are willing to listen and learn, know who they are and the setting in which they serve. Only as we build that community of trust can we truly serve our brothers and sisters. Love means knowing and being known so we can work together. Our eyes see through the lens of wealth, health and abundance—maybe our vision is like the partially healed blind man: seeing men as trees walking. When those with whom we work become truly brothers and sisters, we can see the real world together.
Some examples of others who can help us function effectively:
World Wide Lab Improvement (Ed and Carol Bos) 3607 Gimbrit Circle, Kalamazoo MI 49001, (269.323.8407, e-mail:
mail@wwlab.org) are dedicated to provide appropriate medical laboratory equipment with necessary training and support to church missions overseas.
International Aid (Milton Amayun, MD, MPH, Vice President, Programs) 17011 W Hickory, Spring Lake, MI 49456, (616.935.3621 www.internationalaid.org) sells reconditioned medical equipment and other supplies.
Cherian Thomas, MD, GBGM, UMC, Executive Secretary, Health and Welfare Ministries, 475 Riverside Dr., NYNY 10115 (212.870 3870 e-mail
cthomas@gbgm-umc.org) is a wealth of information about what is and is not appropriate as equipment in mission settings.
Agencies in your local area will often provide valuable information: Medical and Dental Schools have faculty who usually will evaluate equipment offered for use overseas. Call the school and tell why you want the information. Provide the name of the manufacturer along with serial and model numbers.
Check the Web for companies that service equipment. I found a company in Indianapolis, GPS Medical that provided valuable information about ultrasound machines and sells reconditioned equipment.
Finally, check with agencies such as Midwest Mission Distribution Center in Chatham, Illinois or Operation Classroom in Colfax Indiana for information about logistics for container shipping. There are many more that can be found. Let’s just make sure we what we send is useful. Join the club:NO JUNK FOR JESUS
By Donald N. Griffith
