Every year U.S. hospitals discard clean, unused medical supplies worth an estimated US$200 million. "We have a medical system that is wasteful, that is horrendously expensive," says American anaesthesiologist William H. Rosenblatt who, in 1991, started REMEDY (Recovered Medical Equipment for the Developing World) to find ways to channel this unused equipment to medical centres in impoverished countries.
Tackling such a complex issue would be daunting to most, yet in the past 13 years REMEDY has succeeded in recovering significant portions of those unused supplies, fuelled in part by Dr Rosenblatt’s drive and humanitarian vision, qualities that won him a Rolex Award in 1996.
The pilot project he started at Yale-New Haven Hospital in Connecticut has, in its lifetime, collected 32 tonnes of supplies. Cutting hospital disposal costs, it has donated many millions of dollars worth of materials, and the initiative recovers an average of US$500,000 a year in supplies and equipment.
Today, about 200 active programmes in hospitals in the United States have established their own supply-recovery programmes based on REMEDY procedures. Another 59 U.S. hospitals are in various stages of implementing the programme, and those numbers are still rising. REMEDY does not recover the supplies, but advises participating hospitals about distribution methods. All hospitals are encouraged to deal with established charities that have the expertise to transport and distribute recovered medical supplies, and to ensure that recipients are actually getting donations of equipment that fill their needs. Active REMEDY recovery programmes are currently sending supplies to more than 50 countries in Asia, Eastern Europe, Latin America and Africa.
"I credit the Rolex Award for giving us a real start in 1996," Rosenblatt says. "Prior to that, I was mostly working on my own, giving my time to the organisation. Through the Award, we were able to start hiring staff that could do so much more to reach hospitals."
He describes the Award as "very serendipitous" in reaping unexpected benefits. Along with a higher profile and the international media attention that drew requests for information about the pilot project from U.S. hospitals and abroad, REMEDY came to the attention of the Freeman Foundation, a private Vermont-based philanthropic organisation. The Freeman Foundation gave REMEDY a $595,000 general operating grant, enabling REMEDY to hire more staff. Today, the office has one full-time and two part-time staff, along with 100 volunteers.
"The money they’ve given us over the last five years goes to administrative costs for promotion of the programme in the United States," says Rosenblatt. "The Freeman Foundation has allowed us to expand to other hospitals and now we have more hospitals sending tonnes of material around the world." REMEDY at Yale continues to ship supplies to Latin America, its original focus, but, in the past few years, Asia has played a prominent role, in part because of the programme’s connection with the Freeman Foundation, whose goals are to foster cross-cultural understanding between the U.S. and East Asian countries.
"They did not tie the grant money to us working in Asia, but we have felt an obligation to look for outlets on that continent," says Rosenblatt.
Last year, REMEDY at Yale donated several tonnes of supplies to the Philippines through its association with Knightsbridge International, a private, non-profit humanitarian organisation and one of the pilot programme’s main beneficiaries.
Unlike many organisations where only a fraction of funding is expected to go towards administration, REMEDY has found that funds have a far greater impact when invested back into administration. "That administration has the potential to bring in so much more in supplies by allowing us to reach more hospitals, who are the true donors," Rosenblatt says. "The U.S.-based hospital is supporting the overseas group; the more hospitals that get on board, the more our donated dollars are working."
Making a Difference
In the past decade, U.S. hospitals have become increasingly aware of the incredible waste they generate. Part of the problem stemmed — and in many cases still does — from over-preparedness in operating rooms. A surplus of surgical supplies, everything that could possibly be needed for an operation and more, was at hand. What was not used was tossed out. Legal issues, combined with manufacturers’ "single use only" warranties, dictated that any unused supplies — including clean and virtually untouched materials — had to be discarded.
Now, William Rosenblatt points out, hospitals have taken steps to "tighten the belt". He likes to think that REMEDY and others who have called attention to this significant issue were likely catalysts in cost-cutting measures.
Yet these actions, while welcome, have posed serious challenges for REMEDY. The emergence of reprocessing, an entirely new industry that resterilises usable supplies and equipment, is one significant trend. "It’s about a $2 billion-a-year industry," he explains. "Items wasted in the operating room are recleaned, resterilised and sold back to the hospitals at a reduced price." Reprocessing pulls materials away from REMEDY, but Rosenblatt points out that it is only cost-effective to reprocess the more valuable materials, saw blades, for example, or compression sleeves that massage legs and prevent blood clots during surgery. Reprocessors are not interested in basic materials, like gloves, sutures and sponges, valuable supplies that are always in high demand with the charities that distribute the recovered materials.
The solution, Rosenblatt says, is more REMEDY programmes to fill the void. "We have to expand the number of programmes that are participating, and that’s really what funding does — it allows us to reach more hospitals. There’s something like 5,000 hospitals in the U.S. and we’re involved with 200 to 300. We’ve got a long way to go."
Inspiring Lasting Change
Volunteers continue to be the lifeblood of the programme, and REMEDY relies on dedicated individuals — nurses, medical students, hospital staff — to initiate and keep the programme going. Hospitals are highly regulated institutions, wary of legal and medical headaches. He notes that it takes good risk-management staff to realise that REMEDY is a safe programme for the hospital, for the volunteers and for the recipients.
Programmes occasionally falter or become inactive, yet it is the new hospitals and volunteers coming on board who "really take REMEDY to heart", helping Rosenblatt and his staff stay highly motivated. REMEDY can boast a number of what he calls "shooting stars", small, independent charities founded on the REMEDY model that have started consortia to promote and teach the concept to others.
REMEDY also inspires strong loyalty — at times almost too strong — from nurses and other people who feel they are making a difference. When Rosenblatt recently asked operating room nurses at Yale-New Haven Hospital to throw away bulky surgical drapes rather than have them decontaminated and recycled, the nurses were shocked and puzzled.
Rosenblatt explained to the nurses that the paper drapes were difficult to reprocess; in fact, they tied up the system, preventing more valuable supplies from being recycled. The nurses remained unconvinced. For them, wasting any supplies was simply unthinkable. Automatically collecting unused surgical supplies for recycling, everything from gloves to sutures to drapes, had become part of their established routine at the teaching hospital affiliated with Yale University School of Medicine. The nurses had heard the harrowing stories, well aware that recovered medical supplies filled a desperate need somewhere in the world. They knew about doctors operating with torn gloves or no gloves at all. They understood that medical staff in developing countries struggled with scarce resources, and were forced to wash and re-wash items like surgical drapes until they were in tatters.
This was a telling — and gratifying — experience for Rosenblatt, who relates the story with clear admiration for the nurses’ unflagging dedication. "Five or six years ago, they had no concept of how much supplies might be needed, and now they’re fighting me, telling me: ‘How can you ask us to throw them out’?" The nurses’ reaction revealed something even more important to the professor of anaesthesiology and surgery at Yale University School of Medicine. "What this says to me is that, even if I were to leave Yale, the system is embedded. That’s a wonderful thing at this institution."
A Network of Donors
The pilot project at Yale-New Haven Hospital continues to collect medical supplies, yielding on-going studies and research that prove the effectiveness of the programme. REMEDY Inc., the non-profit organisation also housed at the university, was created to teach hospitals how to implement the recovery protocols. Hospitals collect and donate material to U.S.-based charities of their choice, but REMEDY Inc. will also help connect non-profit organisations to active REMEDY programmes. All of the recovered material is sent to developing nations.
"Over the life of the programme, we’ve sent 400 teaching packets to hospitals," says Silvia Botero, REMEDY Inc.’s executive director. "We help them every step of the way, from solving legal issues to problems they may encounter with administrations." Feedback from medical personnel shows that once a programme is in place, it is relatively easy to keep going, requiring only a few hours a week from volunteers.
AIRE-mail is a small but innovative part of REMEDY, developed as a joint project between REMEDY and the Office of International Health of Yale School of Medicine. The programme is a perfect match between urgent requests and available supplies, Botero explains. REMEDY’s database lists more than 900 non-profit organisations that are receiving medical supplies; many of them are willing to go the extra length to retrieve donated medical equipment.
Botero often fields calls from people who may not have an ongoing programme with REMEDY, but who want to donate a piece of capital equipment like an X-ray machine or operating room table that might be discarded otherwise. AIRE-mail provides an outlet for these charities to match their surplus supplies to someone else’s urgent need. In just one week late in 2004, AIRE-mail donated nine gurneys (hospital stretchers on wheels), 30 hospital beds and 40 boxes of supplies. One Texas-based doctor contacted AIRE-mail about an ambulance that was destined for the scrap heap until it was matched to a church group who delivered it to a remote Nigerian location.
A Bright Future
From the outset, Rosenblatt clearly stated that REMEDY would love to put itself out of business, somehow finding a way to strike a balance between more efficiency at home and discovering new ways to supply the developing world.
Back in 1991, he did not suspect that the programme would still be going strong 13 years later, drawing its support from people passionately committed to the concept, nor that tonnes of donations would supply charities and overseas hospitals. "In that way, it has surpassed my expectations," he says. Still, he adds, it could be much more.
"More" means doing the groundwork to bring additional hospitals into the fold, and in the near future, Rosenblatt hopes, adding staff who would travel directly to hospitals to promote the concept. While funding will always be a challenge, Rosenblatt does not want REMEDY to become a "money-making machine".
At the same time, William Rosenblatt and his colleagues hope that eventually almost all the unused supplies thrown away annually by U.S. hospital operating rooms will be sent to the developing world.
Published in 2005