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

by Brandt, David

Industrial Engineer • May, 2008 •

One group of design students researched inventory management systems and made recommendations based on MedShare's needs and affordability, leading them to creating its Web-based inventory catalog.

"This was a big breakthrough because it allowed recipient hospitals around the world to log onto our system and choose, box by box, exactly what they need for their hospital," Hegedus says.

The receiving end

In 2007, MedShare distributed nearly $13 million worth of medical supplies and supplied more than $475,000 worth of medical product to 173 medical mission teams. In order to secure shipments to foreign hospitals in need of supplies, MedShare establishes relationships with corporations, faith-based organizations, and other international nonprofit groups able to carry out long-term financial sponsorships to cover container transport costs.

Recipient hospitals are pre-approved and MedShare encourages transparency through multiple contacts who communicate with MedShare as to the en route status of each shipment, rather than relying on a single person to manage the large and important container of supplies.

Much of the responsibility for security weighs on the recipient hospitals, but they are not without help. Altamirano's nonprofit organization, Latin Steps Services, organizes medical aid shipments and assistance for communities in Ecuador and Colombia, with operations expanding to Honduras and Nicaragua. The expanding reach of his group's efforts, however, largely depends on cooperation and logistics management among individual governments that enforce customs laws and inspection procedures that can sometimes delay the arrival of emergency medical aid to Third World hospitals.

"Our main [challenge] is to be able to deal with the governments and overcome all the barriers presented," Altamirano says. "Even though those countries desperately need [medical aid], unfortunately the governments have laws and regulations that establish not only economical barriers, but political barriers."

In order to maintain a transparent shipping process and prevent material and equipment from falling into corrupt control, Altamirano says there must be a "clear and clean path" for materials to be transported. It's a lesson that was hard to learn: The first shipment sent to Ecuador in 2005, complete with approval of the country's customs officials, was welcomed with additional constraints rooted in paperwork and regulations, as well as personal interests from some seeking "financial benefits," ultimately slowing arrival of aid to local hospitals to almost a year.

Things changed with the second shipment. After higher Ecuadorean government officials--including the vice president--saw what was being shipped and understood more about the efforts of Latin Steps and MedShare, Altamirano says that interest increased in ensuring that the nonprofit effort was quickly processed and that aid reached its intended target. The vice president and other government officials even traveled to the United States to sign a commitment contract with MedShare in an effort to exclude "extra payments" and other hindrances. After that, Altamirano explains, things soon moved much more quickly. The following two shipments each took less than two months to clear customs in Ecuador, while each shipment since has been processed inside of four days.

"A similar situation occurred in Colombia," he says. "You have different laws and regulations in each country, so whatever they are, we have to adapt to their rules. It's not that simple to just bring it in. You have to 'nationalize' those items, where everything is approved and becomes part of that country."

As Altamirano insists, tracking a medical aid shipment is--like MedShare's supply chain--a people-driven task. Contact personnel or Latin Steps agencies are established within the respective country to communicate to the U.S. source the en route status of the container. In most cases, a person is assigned to accompany the container to the point of delivery, as well as organize an official ceremony for the arrival of the aid to the recipient. From point of origin to recipient, each shipment only requires an average of three points of contact.

Into Africa

The need for medical supplies is just as great in African countries such as Ethiopia, the home of businessman Sebri Omer, whose parents sent him away in 1977 to save his life amid deadly fighting between radical university students and a militant government. Omer was brought to the United States in 1980 for residency and education through a United Nations program. He returned two decades later to a safer homeland to begin a hotel company and visit a sick relative in the tourist city of Harar. During his trip home, Omer's plans were stung by the raggedy conditions of a government-run hospital.

"What I saw was just terrible. You have 15 or 20 people in one patient room with various diseases; the floor was dirty; no sheets on the beds; rust ... extremely distressed," he says. "Something just hit me. How can I even think of opening hotels when I'm seeing people suffer like this?"

The epiphany pushed Omer to consider how he could improve the country's health care situation. In 2001, he began by opening a 25-bed hospital on a 4-acre lot known as the Yemage Medical Center in Harar. With the help of MedShare, Omer ordered and shipped electronic beds, bed sheets, a surgery table, ultrasound machines, rubber gloves, gowns, medical utensils, and other medical equipment. Since MedShare's involvement began, the hospital, now a nonprofit, has expanded to a 45-bed facility with room to grow. It is open 24 hours, capable of surgical and emergency medicine procedures, and occupied by 108 employees with at least one doctor on staff around the clock.

Just as it is a challenge in Altamirano's Ecuador, Omer says the logistics of receiving MedShare shipments is delicate. Ethiopian customs agents operate in coastal Djibouti, the nearest port for any goods sought in Ethiopia. Once the appropriate documents are signed and approval of the minister of health is given, the custom agents transport the container to the Yemage for unloading. Each item in the container is verified by customs and checked for safety. Unlike in Ecuador and Colombia, Ethiopia's government has avoided corruption or illegal influences upon Omer or Yemage from the beginning of its retrieval of MedShare shipments, which arrive in about eight weeks from the United States on average.

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Aside from MedShare's assistance, a local Atlanta TV station also helped Omer's hospital by organizing the transportation of an ambulance. World Airways Inc., which has a cargo agreement to transport goods to Ethiopia, had space available in one of its shipments for the donated ambulance and paid all of the transport expenses. The ambulance would be the country's first.

"Sometimes, I think bringing the ambulance over was just a movie.... MedShare's involvement has been extremely critical in the success we have here now, more than any other organization," says Omer, who was still working with MedShare in gaining supplies and equipment as of press time. He hopes that sponsorships for shipments will remain steady, as plans to create the country's first hospice center is next on the hospital's agenda. "Hopefully, we'll continue to have that, so we can continue to save lives."

MedShare intends to build new sorting and distribution facilities in five other U.S. cities in five years, with an expectation of a first shipment leaving San Francisco by the end of 2008. Hegedus says the new locations will likely be based on the highest concentrations of hospitals and population so that there can be a continuous flow of surplus supplies, as well as volunteers to keep the supply chain moving.