Medical Aid Abroad New Zealand - A review of an international aid organization Dr Graeme Woodfield

Medical Aid Abroad New Zealand
                              A review of an international aid organization
                              Dr Graeme Woodfield

Introduction
Many developing countries have problems with meeting the health needs of their
populations. Financial restrictions often mean that the health services are minimally
funded and people are required to depend on their own resources. There is often a
reliance on supporting agencies to carry out a proportion of health services. Charitable
organizations commonly fill gaps in the health services and in some countries, carry
the load of meeting an important proportion of the health needs of the general
population. Not uncommonly, these organizations raise funds in developed countries
to meet some of the needs of their activities and there is often a high input from
Church based or Interdenominational groups. Their role is often greatly valued by the
recipient country although not always widely recognised.

The number of voluntary organizations that have activities in providing health care in
overseas countries is extensive. Although there are often criticisms of Western
societies for not always sharing their wealth, there are still very considerable efforts
being made by some sectors of these populations to meet overseas health needs. The
list of organizations that can provide assistance is very long but many countries are
poorly informed of the help that can be made available. Electronic communications
may soon mean that many countries will be able to access specific data that will be
helpful in various areas of their health needs.

The following is a review of one low-key community based voluntary health organi-
zation, which over a period of 30 years has been able to provide substantial assistance
to developing countries.

The organization
Medical Aid Abroad New Zealand (MAANZ) is an organization that is small but
effective in the work it carries out. Its main aim is to provide pharmaceuticals and
medical and dental equipment for developing countries as well as engaging in other
related activities such as health personnel training. It has been functioning since 1967,
and is supported by a variety of voluntary, medical and pharmaceutical established
organizations. It is a voluntary and charitable society, depending entirely on the input
of many motivated people and operates on a very low budget provided by its
members.

It was founded in 1966 by a group of doctors, pharmacists and lay persons in
Christchurch. Over the years, other branches developed in Dunedin, Wellington and
Auckland (1). It is an incorporated society with Rules of Association which have
recently been re-formulated to meet present needs and the name changed from MAA
to MAANZ. A list of MAANZ supporting organizations is noted in Table 1.

Medical Aid Abroad New Zealand 2

TABLE 1: Supporting organizations for MAANZ

          NZ Medical Association                       World Vision NZ
          NZ Dental Association                        National Council of Churches
          Pharmaceutical Society                       Order of St Lazarus
          NZ Red Cross Society (Inc)                   Catholic Church
          Volunteer Service Abroad                     Council for Mission

Mode of operation.

                                   Incoming supplies
Drugs and equipment comes from individual pharmacies and hospitals that MAANZ
has had contact. Pharmaceutical manufacturers and wholesalers have not
uncommonly donated large quantities of goods while equipment comes from a variety
of sources such as hospital salvage stores, ex-government stocks, redundant hospitals
and individuals. A system has evolved in Auckland whereby Community Laboratory
couriers deliver goods to a central collecting area for later transport to the main
storage area.

For many years, MAA accepted drugs for recycling that were past their expiry date. It
is well known that the vast majority of drugs are still therapeutically active for a
considerable period after the printed expiry rate although there may be a slight loss of
potency. On this basis drugs were recycled and often pooled, then relabelled in new
containers. Present policy is now to only accept in-date drugs for distribution. There
are several reasons for this change of policy. Firstly, some developing countries do
not allow the importation of outdated drugs because of quality concerns. Secondly,
the World Health Organization has issued guidelines that discourage the donation of
expired drugs to Third World countries. These guidelines were issued in response to
the dumping of huge quantities of unsolicited and often inappropriate medical
supplies by some agencies in areas of humanitarian crisis (2).

MAANZ has a conservative attitude and ensures that all drugs released for issue have
been checked by pharmacists and are in date. Exceptions only occur when local health
staff assures MAANZ that the drugs will be stored and used appropriately and rapidly
and this requires personal liaison with the Doctor in charge of the hospital or health
centre.

A wide variety of medical surgical dental and laboratory equipment is handled and
this comes from many sources. MAANZ cannot normally refurbish equipment
although at times this has been done on special request. At times, large items of
equipment that are redundant have been located such as renal dialysis machines, X-
Ray equipment, hospital beds and operating tables. There is still considerable
potential for recycling of equipment from hospitals although there are logistic diffic-
ulties in handling and storing all that is offered.

Medical Aid Abroad New Zealand 3

                                   Sorting of incoming Goods
Volunteers, usually pharmacists, doctors and dentists perform this. This is a time
consuming activity, usually performed in the evenings. There is a high discard rate of
incoming goods, which results in problems of disposal. Goods are placed in desig-
nated shelves in the storeroom and the stores are regularly checked to ensure that over
dated drugs are removed.

                                   Packing of Incoming Orders
Volunteers pack these. Special request forms help to define what is needed and where
goods are not available, the order is filled with the nearest drug equivalent. There is a
high turnover of goods and not all orders can be fully met. There is a high demand for
antibiotics, skin, eye and ear preparations, as well as drugs for the treatment of
tropical disorders. Bandages, dressings and other similar goods are always in short
supply and are seldom in the store rooms for long.

Once packed the goods are ready for collection or delivery to a specified location.
Wherever possible the recipient organization is asked to pay the costs of transport of
the goods although at times MAANZ does assist with this. There are usually
sponsoring organizations that are available and many requesters are able to make
suitable arrangements. At other times use is made of the Air Force or Navy to
facilitate delivery while on other occasions airmail post is used. It has been increas-
ingly common for persons working in third World countries to visit the MAANZ
storerooms and select their own requirements and then arrange the transport of the
goods. At other times MAANZ has worked with Government organizations to
facilitate the delivery of goods and this has resulted in some very large deliveries to be
made eg container loads to Vietnam.

Orders packed and delivered over the last 4 years are listed in Table 2.

Table 2: Orders processed by MAANZ over the past 4 years.
                                         1997         1998        1999     2000
       Orders processed                 25          30          27       48
       Areas orders sent
       Pacific* (%)                     64          53          52       50
       Asia† (%)                        28          20          19       30
       Africa, India‡ (%)               8           23          19       10
       Others¶ (%)                      0           4           10       10
*PNG (incl.Bouganville) Solomon Islands, Cook Islands, Tonga, Nuie
† Vietnam, Cambodia, Mongolia, East Timor, Philippines b
‡ Somalia, Mozambique, India
¶ Others includes Azerbaijan, VOSO and Mercy Ships

Rooms
One of the biggest problems for MAA is the availability of low cost rooms for the
activities of the organization. The present rooms are inadequate for all that is done and

Medical Aid Abroad New Zealand 4

MAA is actively exploring other options. Ideally, MAA needs to find storerooms in
close conjunction with some other charitable organization that has related aims.

Feedback
All orders include a feed back form inviting information on a variety of matters
including suitability of transport, appropriateness of the goods, and other comments.
This has helped to provide a good service and the evidence of this are the large
number of grateful comments MAANZ receives.

Administration
The MAANZ executive meets bimonthly and holds an Annual General Meeting. All
positions are voluntary and most members have had experience in developing
countries. The time is coming when a part-time paid position may be required to
ensure that all the activities are maintained to a high standard.

Other activities.
MAANZ has occasionally sponsored overseas health staff to New Zealand for
training. In the past it has a provided lists of paid and unpaid positions available for
New Zealand health workers in developing countries. MAANZ also sponsored a visit
to Vietnam by a medical team and plans to carry out other such activities in the future.
Sponsorship of medical student on an elective project in the Pacific was a useful
project providing helpful information on the effectiveness of the work of MAA.
Recently a radiographer from Africa was supported for specialist training in New
Zealand.

The introduction of a website (www.maa.org.nz) has been a useful innovation, and
this provides up to date information on the activities of MAANZ. It also provides a
list of links to other websites in other countries and particularly to organizations
carrying out similar or related functions.

Discussion.
MAANZ has now been functioning for over 30 years and during that time has been
able to provide relatively large quantities of drugs and equipment to many third world
countries and particularly in the Pacific. On average about 60% of goods are delivered
to Pacific Island countries with the remainder going to Asia and even further afield.
An average of over 40 orders are processed nationally each year going to as many as
20 different countries. Some orders may be very large, such as Container loads
although most orders will be for 2-3 boxes of goods. However even a small box can
contain a very valuable consignment of goods and is a welcome addition to supplies
obtained locally. Some clinics have become almost dependent on the goods we can
supply and very large multiple orders have been required.

The organization has been able to provide special support in times of emergency.
Goods were sent to East Timor, to tsunami victims in Aitape in Papua New Guinea
(PNG) and large deliveries have been made to Bougainville in PNG.

Medical Aid Abroad New Zealand 5

MAANZ is at present faced with a number of challenges. In particular, accom-
modation is a major problem that needs to be solved soon. Recruitment of new active
members is an ongoing problem although this is a common feature of voluntary
organizations particularly in a society where many motivated people are already fully
occupied. There are difficulties in always obtaining high quality pharmaceuticals in
sufficient quantities to meet requirements. Although we prefer to work with non-
governmental organizations in developing countries there is pressure to provide goods
to government agencies and this may require a different approach from the present
one. Another problem is that the only active branch of MAA is now in Auckland, as
ageing, lack of new volunteers and other factors has resulted in the closure or recess
of the other NZ branches. There is a need to reactivate the national organization and
to make better use of the large amount of health related goods that are presently
discarded from our many hospitals.

On the other hand, the members of MAANZ are highly motivated and work hard to
meet the evinced needs. The demand for services is growing and with population
pressures increasing there will inevitably be even more requests in the future for the
services we offer both in emergency and non-emergency situations. MAANZ is
planning for this and upgrade its operations and to find new ways to meet the
challenges of the future. In particular a major project is underway to provide low cost
computer technology to developing countries

Summary
MAANZ is a little-known charitable voluntary low-key organization committed to
providing high quality pharmaceuticals and equipment to developing countries and
carrying out a number of other health related activities. The organization works best
with nongovernmental groups and has developed an informative web site. It has an
enthusiastic and informed core group of participants and has innovative plans for the
future. It is a good example of how a small group of people can considerably assist the
development of community based hospitals and health centres.

References

Nicholson G, Woodfield G. Can “charitable” drugs be a useful form of aid? The New Zealand
experience.Tropical Doctor 12: 90-91 1982

Hogerzeil H, Couper M, Gray R Guidelines for drug donations Brit med J 314 737-740 (1997)

The Author
Dr Graeme Woodfield,
Chairman. MAANZ
Box 26-336
Auckland 3