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So… where does all the stuff go?

Brigitte blogs from Haiti, where the Médecins Sans Frontières / Doctors Without Borders maternity hospital is closing. This week she writes about the process of closing the hospital and what is done with leftover supplies...

where does all this stuff go

There’s a joke within MSF, you cannot go a day without looking at an excel spreadsheet! But all joking aside, these spreadsheets, although complex and sometimes uncooperative, are essential. They ensure we have an overview of everything human resource related, finance related and especially everything supply related. I’ve always been impressed with the supply spreadsheets flagging medication before it runs out or is about to expire. This way we can make an emergency order to prevent a rupture or give donations before the medication is wasted sitting in our warehouse. I often use the example of these spreadsheets as how MSF rationally spends donor funds. And now I’m even more impressed with them as these spreadsheets have been imperative in the closure of CRUO.

CRUO was an enormous project, a referral center for complications of pregnancy and delivered approximately 500 babies a month. This means we had a lot of equipment, tons of furniture and a 6-month reserve supply of medication (which means it was more than a lot!). With the help of our trusty spreadsheets, we knew that we were not going to consume everything we had in stock before the hospital closed. So… we donated it! Upon my arrival to Port-au-Prince the donation process was already in full swing. Using our multiple spreadsheets, the 6-month backup supply was distributed between other MSF projects within Haiti and local public and public-private hospitals. One day, I provided a tour to our colleagues working at the MSF severe burns hospital showing them around CRUO so that they may identify items they would be able to use within their hospital instead of ordering them internationally and awaiting their arrival. Other MSF hospitals were always the priority for donations as the materials and medications were bought by donor funds, and therefore, should be recycled back into MSF and used responsibly. However, we also wanted to leave the public Haitian health structures, which ran obstetrical and neonatal services, with medication and supplies to continue providing for the at-risk population the best they could. 

One of three temporary storage rooms before adding the boxes of medications to be donated

One of three temporary storage rooms before adding the boxes of medications to be donated
One of three temporary storage rooms before adding the boxes of medications to be donated

Subsequently, with the closure of each room, the furniture and equipment used within that ward was also donated the following week. Our stock of hospital beds, bedside tables, desks, chairs, bassinettes, oxygen concentrators, linen, IV poles, privacy dividers, staplers and binders (you name it) decreased monthly so that we wouldn’t end up with hundreds of thousands of items to distribute upon closure. It was very strange seeing rooms, which were previously full of the hustle and bustle of staff and patients, alive with the cries of newborns and calming songs of mothers, completely bare. An entire hallway was emptied, as was an entire operating theatre by the end of May.

Empty triage

Empty triage
Empty triage

It was sobering reading the requests from different structures. To realize just how little these structures had in terms of supplies and medications yet somehow were still serving the population. 

During the months of June and July we began receiving letters and requests from various structures across the country asking for donations. Interestingly enough, wall clocks were a very in-demand item. It was sobering reading the requests from different structures. To realize just how little these structures had in terms of supplies and medications yet somehow were still serving the population. Even more so, hearing the stories from my Haitian colleagues about the time they brought a family member to such-and-such hospital for treatment, and they spoke about the conditions patients were in and how little was available to treat patients. I did witness a few local hospitals myself and I was once again very thankful for the free quality healthcare provided in Canada.

Donation rush

Then, on July 15th, when we closed to admissions, came the real rush of donations. Certain wards, such as triage, closed immediately and were emptied of years worth of equipment. In other wards the moment a patient was discharged, out came their bed and accompanying accessories. We had an overstock of diapers, baby wipes and mosquito nets that mothers got to take home upon their or their infants’ discharge. On July 23rd, there were no more patients but thousands of items to be donated. After the MSF hospitals took what they needed, the requests from various health structures were reviewed. We kept prioritizing structures with a focus on maternal and child health and, with the local knowledge of the national staff, distributed according to population size served, the need of the hospital and public/free healthcare provision. 

François, a pharmacy assistant, working hard sorting and boxing medication for donations

François, a pharmacy assistant, working hard sorting and boxing medication for donations
François, a pharmacy assistant, working hard sorting and boxing medication for donations

The pharmacy team worked tirelessly making batches of donations from the leftover medication in our central pharmacy and boxing them up. The logistical team cleared each room of its contents and stockpiled it in our temporary storage facility (the empty wing of the hospital). Then it was up to Dr.Lubin, our assistant medical director, and myself to divide the items according to health structure and make an inventory list. It was a 2-3 day endeavour, we made and updated many spreadsheets, got covered in dust and used muscles I forgot I had but once the health structures began arriving our efforts were definitely worth it. We were able to donate to 9 different health structures, from primary basic obstetrical care clinics to large community hospitals providing C-sections and other life-threatening obstetrical emergency surgeries and for structures about 20 minutes away to 8 hours through bush and winding roads. Almost every structure received a wall clock, a supply of various medication and office furniture. One thing is certain, every structure received items that will help provide healthcare to the Haitian population. The representatives from each structure were very thankful and guaranteed that the items will be put to good use. It was impressive seeing how much stuff was previously in CRUO, but even more impressive was how skilled the drivers were at arranging large wooden shelves, armoires and/or desks on top of pick-ups in order to make a single journey. 

Medication, material or equipment were not the most important things we left behind in Haiti, more so, we left a very qualified workforce to continue providing quality health care to the Haitian population. 

However, medication, material or equipment were not the most important things we left behind in Haiti, more so, we left a very qualified workforce to continue providing quality health care to the Haitian population. Throughout the staff’s careers with MSF, they have had many trainings and professional development opportunities such as monthly morbidity and mortality rounds when maternal cases are discussed and how they could be avoided or better managed in the future, scientific Thursdays, an opportunity for each department to present a topic ranging from the rational use of medication from the pharmacy department or the benefits of breastfeeding from pediatrics. There was internally organized training such as hands-on training for the hygienists and cooks on infection prevention and CPR refreshers for the medical staff. We have had the opportunity to send our staff to Haitian national training sessions, such as how to become an advocate for mental health services and some to international training sessions organized by MSF. With the closure of CRUO staff received curriculum vitae and motivation letter training, excel training and training on time management and communication. So although CRUO has closed its doors, we are still providing health care through the material and manpower left behind.

Dr. Lubin and Patrick, the heads of the hygiene committee. A committee that would organize activities every 2 weeks to promote and teach hygiene practices within CRUO. 

Dr. Lubin and Patrick, the heads of the hygiene committee. A committee that would organize activities every 2 weeks to promote and teach hygiene practices within CRUO. 
Dr. Lubin and Patrick, the heads of the hygiene committee. A committee that would organize activities every 2 weeks to promote and teach hygiene practices within CRUO.