Voluntary parts: time and money donations fuel MedShare International's supply chain of aid.

IN THE GLOBAL MEDICAL COMMUNITY, THE DISPARITIES in the quality of supplies and equipment are too obvious to overlook. Routine tools, blades, and protective clothing used in surgical or emergency procedures in medical centers are plentiful among richer countries such as the United States, Canada, or Great Britain. Ironically, some of the very countries where such materials are manufactured are missing them. What's as common as bread and butter to some is a rare treasure to others--particularly in the Third World, where that treasure is so critical to survival.

Just ask Dr. Jaime Altamirano, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention. His home country of Ecuador faced torrential rains and flooding caused by storms born out of La Nina weather patterns earlier this year. Hospitals and clinics are also being flooded--with patients who can't be guaranteed quality care because of a limited space and, more significantly, scarce supplies.

"The government is facing the needs of the community," Altamirano says. "[The flooding] started in January and is predicted to last through the end of April. As of now, five provinces are affected, and all those hospitals and health care facilities are overcrowded, ill-equipped, and without supplies. Poverty is a difficult word for the people, but when you talk of poverty in institutions, you're talking about less-than-needed staff, poorly paid staff, and no supplies."

The case for improving a country's health care system isn't always a matter of revolution. In many cases, it's simply a drive to heal and care for as many people as possible. Unfortunately degraded hospitals and clinics often lead to failure despite the noblest efforts because they lack the necessary tools. Such a scenario is a familiar environment in dozens of countries, particularly in Latin America, Africa, and along southern Asia.

Through its personnel-fueled supply chain and distribution operations, MedShare International--a nonprofit organization based in Decatur, Ga., near Atlanta--aims to be a remedy for global health care shortfalls. Founded in 1998, the group collects, recycles, and distributes surplus medical supplies and equipment from health care systems nationwide, with nearly one-third given by hospitals and clinics in the metropolitan Atlanta area.

Wills Moore, MedShare's director of operations, says that routine donation pickups and deliveries by U.S. health systems bring thousands of pounds of materials and equipment that would otherwise be thrown away. The bestowed items are collected, sorted, and stored within MedShare's inventory warehouse and held until the items are requested by global recipients in need. Since its inception, MedShare's inventory flow has been almost nonstop.

Moore also says that MedShare's operation combats a negative tag sometimes placed on humanitarian aid organizations--such groups are only giving what they have. But the group essentially maintains a medical surplus treasure chest for Third World health care requests, fulfilling as much of any wish list made by those who are asking for aid.

"The big rap against humanitarian aid, in general, is that 'we're not sending what they need, but what we have.' A lot of organizations will take a big bag of unsorted supplies and just send that. What we're doing is creating boxes of the same item, putting that into our inventory system, and when an [international] hospital receives approval to receive a shipment, then they can go online and order item-by-item."

Think of it as Amazon.com for medical surplus, Moore adds. A sample list of requested items given by MedShare to Industrial Engineer essentially resembles a how-to guide on building your own medical care operation (minus pharmaceuticals, which MedShare does not collect or include in its donations). Almost every letter in the English alphabet has at least three items attached to it--drains, drapes, and dressings (with gauze and tape); plastic ware, procedural trays, and pulse oximeters; stethoscopes, sutures, and syringes. Almost any American hospital can corral such a list without worry.

Don't expect Altamirano's Ecuador to relate. "When I came to MedShare, I found they were a good resource of medical supplies and equipment that could be used to assist in a larger way to our needs," he says.

Med sharing

The medical items donated to MedShare are often sent to the garbage among most hospitals, Moore says. Some tools and in-between knick-knacks are part of whole kits that hospitals can't use following a surgical or medical procedure or don't have time to place back into its own stock. Other products can't be used due to government regulations, production overages, damage to the cosmetic package, or new tools that make the older models obsolete.

"When you talk to nurses in areas we're [seeking donations from], it's so devastating for them to see that stuff going in the garbage," Moore says. "They're thrilled to know that we've got solutions for that."

The solution operates almost entirely by a volunteer-driven system. Students, area health workers, and even those with mental or physical disabilities frequent the MedShare facility to filter thousands of pounds worth of medical supplies. The volunteers are first introduced to the system with brief instruction, explaining how tools need to be sorted, how to find expiration dates, and how to make a box full of a particular item for inventory.

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Incoming supplies are divided among four or five tables, each surrounded by volunteers seeking specific items and sorting them into boxes that will later be marked and accounted for within MedShare's electronic inventory tracking database. MedShare staff monitor the volunteers, answer questions when necessary, help remove surplus that absolutely cannot be useable, and enter inventory data into the system, which managers of international hospitals and clinics access to pick which items they most immediately need.

Quality management is a collective effort among the various members of the operations team, says MedShare's national development director Danielle Hegedus. A collaborative partnership manager focuses on in-kind product and equipment donations; a biomedical engineer works on procuring, assessing, and repairing biomedical equipment; a staff inventory and logistics manager monitors fulfillment of container shipment orders; and a distribution center manager focuses on order fulfillment and scheduling donation pickups.

"We have defined certain standards regarding products and equipment that we can and cannot accept," Hegedus says. "There is a fairly high quotient of 'junk' that is offered to organizations like ours, so we are continuously trying to improve our processes for assessing potential donations and ensuring that we only accept and ship items which our recipient hospitals really can use."

The sorting room at MedShare has no assembly line or any other kind of mechanics or robotics that common manufacturing or distribution centers include. But volunteers--usually more than a dozen to as many as 30 in the room--are able to maintain a moderate pace in their sorting, mostly thanks to the 25 or more examples of surplus tools and items they're asked to look out for in the sorting process.

For example, if a volunteer is asked to collect syringes for inventory, they are able to look at and touch different examples of syringes that hang from one panel. In front of that panel is a 60-gallon barrel with a large plastic bag, which is used to contain syringes found by other volunteers who are tasked with finding other kinds of supplies. The items in the bag are then emptied onto a sorting table at a later time so that they can be included in the inventory. Neighboring rooms at MedShare include bundles of utensils and electronic equipment, most of which are contained in buckets, wall pockets, or shelves.

The key aspect of MedShare's operation is arguably the 48,500-square-foot inventory warehouse, which resembles a typical Sam's Club grocery store--shelf after shelf of items boxed and sitting on pallets waiting for loading and shipping. MedShare officials say the average value of inventory in its warehouse at any time is around $7.5 million. Supply orders are shipped to various countries in 40-feet-long containers that stand about 8 feet tall and 8 feet wide. Each container can hold roughly 1,000 standard supply boxes or up to 12,000 pounds.

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And though there are no formally trained industrial engineers on staff, MedShare officials keep an eye out for how their system can be improved. They've already had help from several undergraduate IE students from nearby Georgia Tech, many of whom have partnered with MedShare staff on research and design for handling a supply of stainless steel surgical instruments.

"This was a particularly amazing group as they worked beyond graduation to finish the project," Hegedus says. "Stainless steel instruments are tremendously valuable to clinics in developing countries but so cheap to make that we treat them as disposable items here in the U.S."

Other students performed an analysis of MedShare's sorting process, looking at the aging process of the inventory through random sampling. They also examined sorting barrels and made recommendations for that process, most of which were implemented. The warehouse layout was also examined, leading to a rearrangement of the inventory where fast-moving items are placed closer to the loading dock.