Following a $4B donation of pharmaceutical drugs to Guyana’s public healthcare system, United States not-for-profit humanitarian organization Direct Relief says that while some of the medications are due to expire shortly, it hopes that all can be used since the donation was based on specifically requested quantities by the Ministry of Public Health.
“We would hope that all of the drugs would be fully utilized. We do not want the burden of disposal on anyone else… we do not send anything unless requested,” Genevieve Bitter, who is the Director of Operations for Direct Relief, told Stabroek News via phone.
In April, the Los Angeles, California-based organization donated US$20.8 million or $4 billion in medical supplies, ranging from Albuterol Sulfate to Acetaminophen through the Guyana Medical Relief (GMR) organization.
However, some of the medications, including Prochlorperazine Maleate and Empagliflozin, which came in amounts of 3,412 and 3997 boxes, respectively, are due to expire on June 30, 2017.
Others, such as Simvas-tatin, Claritin, Tolmetin Sodium, Vitamin B3, have expiration dates ranging from August 31, 2017 to February, 2018.
Local GMR representative Sharir Chan told Stabroek News that he felt offended by a recent Guyana Times report that seemed to imply that his organization flouted import laws, was being used to benefit from tax write offs in the US for the donor organization, and that Guyana was being used as a dumping ground. “I don’t know the objective behind that article, but it seemed kind of political,” Chan said.
He explained that his organization has been meeting with hospitals directly to verify drugs that are needed before approaching Direct Relief for assistance. He said that although the expiration dates on most medications would be about six months to about a year, the drugs are given in amounts that would be utilized in the short timeframes. If additional medications are needed when they are depleted, the cycle continues.
Chan said that drugs brought into the country are United States Food and Drug Administration (FDA) approved and are not generic but “top notch” and meet the local Govern-ment Analyst-Food and Drug Department (GA-FDD) guidelines.
Officials at the Ministry of Public Health told Stabroek News that the drugs were indeed requested by it and that GMR’s request to Direct Relief came after a meeting with the ministry’s Materials and Management Unit (MMU).
“It was requested by ministry and they got the list from MMU,” Public Relations Officer Terrence Esseboom said.
Over at MMU, an official who requested anony-mity, said that the supply was received and that distribution has commenced.
‘Requested’
This is the first time, according to Chan, that such a large volume of drugs was delivered but he believes that it will be used since it caters for distribution for the entire country.
“We are partnered with Direct Relief to help Guyana. The $4B came from them. We do not send anything unless requested by Guyana. This mass shipment came as a result of the known shortage of drugs in the public healthcare system. We approached Direct Relief with a request. Ministry gave us a list of available supplies and we shared it with them. I want to make it clear that everything here was requested by the Ministry of Health and they know that the drugs’ expiration dates,” he said.
“The $4B may look like a large amount but it is not for one specific hospital, say Georgetown or New Amsterdam, it is for the entire country. Those things were ordered since March and it came around April 20, 21. Once it arrived, it belongs to the Ministry of Health, not us. It is up to them now to disburse as per the needs in the regions as they see fit. The volume is based on amounts that can be used and as requested. They calculated the amounts and then passed on the information to us. We in turn passed it on to Direct Relief,” he added, while noting that the organizations have had a partnership for 30 years.
Bitter said Direct Relief has never sent any drug here that was not requested and would never use this country to dispose of excess medications since they have disposal better disposal mechanisms.
“We are not in the habit of sending anything that is not specifically asked for and approved. We don’t just formulate shipments here. The list is reviewed two and three times before the shipments leave here. Everything that we donate… we send on a needs request basis. We have been supporting the hospitals in Guyana with GMR over the years and they do kind of all of the ground work; that is, liaising with all of the hospitals. Direct Relief was responsible in getting donations from major pharma companies and manufacturers.
“We have an online portal which we make available to hundreds of partners worldwide. We work in 80 countries and we make our inventory available, and then partners can go and log in and view what is available and place an order that way. This particular request came… was the first that was handed over to the Ministry of Health and came as a request due to a shortage of medicine. We heard that there has been difficulty over the last number of months procuring what was really needed in the country. So we made our entire inventory available and GMR worked with the ministry’s pharmacist, to review the list and make the selection. That is how we came to put together the specific lists,” she added.
Bitter noted that an agreement with partners would not allow for the organization to burden any country with disposing of its medications and it was why drugs are only sent on a needs and request basis.
“If there are large costs that is involved in the destruction, that is something we can help with. We have an MoU with all of our partners and there is a detailed sheet that asks if there is anything to dispose that you can’t, we don’t really get much of those. We have sent over US$1B in donations and very, very little waste we are informed of. It is not a typical situation where there is a lot of waste but we do help organizations to have the medicines utilized before expiration,” she noted.
“No tax write off”
The Direct Relief representative also said that her organization understands if concerns are raised but wanted the public to know that it is a not-for-profit humanitarian organization and there was no tax write offs to be had.
“The only entity that is allowed a tax write off is the manufacturer of the medicines, so the large pharma companies and manufacturers who donate to Direct Relief. I believe they get a tax break from that but Direct Relief does not get any sort of tax breaks,” she said.
Explaining how her organization works, Bitter said that Direct Relief acts as “more of a broker” with United States pharmaceutical companies and manufacturers in donating excess amounts to charity, rather than having it destroyed.
“We are a non-profit organization distributing to other NGOs and ministries of health all over the world. We really just have a good relationship with the pharma companies and try to serve underserved populations who don’t necessarily have a budget to buy medicine or have access direct to the companies that make them. We serve more or less as a broker or supplier trying to tie the supply with the demand,” Bitter said.
She emphasized that there is no tax incentive for Direct Relief to get involved. “We are simply just trying to take excess production that the companies here in the US are overproducing and destroying… every quarter of every year… we are just trying to leverage that with a ministry or a hospital who really is in need of it but don’t really have a budget to procure it,” she said.
Addressing the issue of the expiration dates on the drugs donated, Bitter said that while she was not privy to all the guidelines, the onus is on the consignee to bring in only drugs that qualify under its country’s guidelines.
“Nothing leaves here unless we know sufficient approvals have been met. That is how that shipment came about. I am not sure if those quantities are too great or not enough, I can’t say what the exact needs are for the country are, but that it why we do partner with GMR to obtain what is needed; that information and specifics,” she further said.
‘Transportation support’
With countries such as Guyana, where there are remote areas to get to, Bitter said her organization understands the urgency in getting the drugs distributed and the challenge posed by limited resources. As a result, she said Direct Relief has volunteered to assist with transportation funds. “We can also help with in country transportation and logistics. We would give some funds to assist because we know somethings have to go by boat there and so forth. If the Ministry of Health feels they don’t have the resources needed to distribute the medications in a timely manner, we certainly want to help. We don’t want there to be any limitations there,” she explained.
“We have offered that to GMR and… we are here to support them and if they need help in getting to remote regions, then you know we can try to assist in that,” she added.
