Pills to Africa: how to donate effectively John H Day, clinical research fellow, Aurum Health Research, PO Box 87, Welkom, 9460, South Africa jd@aghs.co.za Christopher B D Lavy, consultant orthopaedic surgeon. Malawi Against Physical Disability, PO Box 256, Blantyre, Malawi lavy@malawi.net © BMJ 2001 It's amazing what you can find in the pharmacy of a rural mission hospital in Africa. Many are heavily dependent on the generosity of supporters in the northern hemisphere for valuable supplies of antibiotics, diuretics, and oral hypoglycaemic agents. Unfortunately, well intentioned, but inappropriate donating can also turn developing world hospitals into dumping zones for pharmaceutical junk, sent on the basis of "anything must be better than nothing." Guidelines for responsible donating Donors Ask first before collecting/despatching Seek advice on the best method of transportation and completion of customs declaration form Discuss local policies on expired and near expired items, antibiotics, antivirals, and psychotropic drugs Enclose an itemised list in the official local language, including generic drug names (recipients may not be familiar with trade names) and information on shelf life Recipients Investigate if your country has its own drug donation guidelines Ascertain information on the local policy regarding expired products Send a copy of the local drug policy/essential drugs list to your regular donors or a shopping list of useful products For equipment, consider practical details such as "What will it plug into?", "How will it be maintained?", and "Who will benefit from it?" Learn to say "No" without fear of causing offence Twenty days' worth of small packs of doctors' free samples of the latest calcium channel blocker will not control a patient's hypertension for long, but might fill a gap while stock of a diuretic is awaited. Six vials of a third generation cephalosporin that have passed their expiry date may breach local policy, but, faced with a child with meningitis failing to respond to penicillin, could save a life. However, the Zambian mission hospital in receipt of a box of amphetamine based appetite suppressants would no doubt still be awaiting a suitable candidate had they not been consigned to the bin. Anyone employed in the health sector of industrialised countries experiences a disposable culture that contrasts sharply with the needs of hospitals in the less developed world, where surgical gloves may adorn washing lines awaiting a second or third visit to the autoclave for resterilisation. Many theatre nurses in the northern hemisphere faithfully collect unused gloves and suture material to send to health institutions that can make use of them. Some with greater ambitions appear to be encouraging operating theatres in Malawi and Uganda to extend their surgical repertoires by dispatching many metres of cardiopulmonary bypass tubing to them. Of course, recipient hospitals are free to dispose of donated items that they cannot use, but even this can become an administrative headache. Facilities for safe storage and disposal of medications may not be available. In large quantities medications can become a chemical waste problem threatening environmental contamination. Venezuela struggled to deal with huge quantities of medical aid donated after floods and landslides two years ago. Costly disposal measures have also been required in Armenia, Mostar, and Kosovo. Swingeing import duties and transport costs have often turned a consignment designed to bless into a bureaucratic curse. Negotiating with a department of customs and excise can be a time consuming and morale sapping process. It took a colleague in Uganda two years to clear a consignment of medical supplies. On final inspection, officials then found the expiry date of a large quantity of surgical gloves to have passed and slapped the surgeon with a bill to cover the cost of destruction of the offending items. The World Health Organization recently updated its guidelines on drug donations and urged donors to ensure that their donations are of maximum benefit to the recipient; respect the wishes and authority of the recipient; strictly avoid any double standards in quality; and are based on effective communication between donor and recipient. Six donor countries and 13 recipient countries have now developed their own drug donation guidelines. Good drug donations save lives and are much needed, especially in times of crisis. The indirect benefits should not be underestimated either. The collection of drugs and medical products can act as a focal activity for supporters and donators, promoting interest in the work of a mission hospital or relief organisation and a sense of meaningful participation. [back]