Across the world, access to medical equipment is a problem with implications ranging from the individual to institutional level. In under-resourced areas, doctors and nurses are unable to properly perform their jobs due to a shortage of medical supplies, with the result being an abundance of preventable and early deaths, as well as decreased health and quality of life. In places where there is simply not enough adequate medical equipment to treat the population, how can more fortunate nations help? Building on this, what kind of help is appropriate to provide, and when should we step in?
At Project C.U.R.E. Nashville (Commission on Urgent Relief and Equipment), the efforts of manufacturers, governments, foundations, corporations, and local volunteers all culminate into a driving force that aims to provide medical relief to over 130 nations across the world through donated medical supplies. Project C.U.R.E. is a national organization headquartered in Denver, CO, with warehouses and distribution centers across the country (one of which is located in Nashville). Project C.U.R.E. partners with hospitals, medical manufacturers, and wholesale distributors in order to obtain excess medical supplies and retired medical equipment, with the goal of repurposing and redistributing these medical resources to countries that lack an appropriate quantity or quality of care-providing measures. They are the world’s largest distributor of medical supplies and equipment, and the largest by far. Project C.U.R.E. sends out around 200 containers annually, whereas their closest competitors do around 12. The average value of a container of Project C.U.R.E.’s donated medical supplies is $400,000-$450,000. As Project C.U.R.E. Nashville’s Executive Director Cheryl Noe puts it, “we exist to bridge the gap between resources and those who do not have the resources and do not have the voice.”
Living in the United States, where we experience an abundance of medical resources, it can be difficult to visualize how resource-deprived some medical facilities are. In this clip from “Grey’s Anatomy” (S9, E20), two Syrian doctors visit the Seattle hospital where the show takes place, to learn how to perform basic surgical skills with reduced medical equipment. While the American doctors thought that they had accurately replicated the resource-deprived circumstances that the Syrian doctors were working with, they were soon shocked to find out just how little the Syrians actually had at their disposal. See timestamps 0:00-1:21 of the below video.
As shown by the reactions of the American doctors, the scarcity of resources that some medical facilities have to operate with is shocking, and oftentimes chilling. This perspective is one that not many Americans will ever experience or observe first-hand, so in order to fully understand the impact that Project C.U.R.E. can have, creative works like this scene are extremely useful. In this scenario, the Syrian doctors are experiencing resource-deprivation due to wartime circumstances. However, Project C.U.R.E. helps countries not only ravaged by war, but also natural disasters, genocide, pandemics, or simply just lack of financial means to build comprehensive medical infrastructures.
To start off this process of providing aid, Project C.U.R.E. must first receive an invitation. This is extremely important, as Project C.U.R.E. only goes where they are invited. As Noe puts it, “it’s going to work better if they want us on the ground, if they’re asking for us, and want to partner with us. But we also don’t want to do the whole white savior thing, where you swoop in, and you leave stuff, and then you feel great, and then you leave. We want to do what’s best for their system to sustain what they need sustained.” Operating under this fashion establishes better diplomatic ties, ensures that the most appropriate and necessary supplies are prioritized for each individual facility, and provides a way to ensure that the work done by Project C.U.R.E. is as meaningful and effective as possible.
After receiving an invitation, Project C.U.R.E. conducts what they call a Needs Assessment. In a Needs Assessment, Project C.U.R.E. sends a trained assessor to the facility requesting a donation, and according to Noe, asks questions like “What’s your population? Who do you serve? How many births did you have last year? How many deaths? How many bones did you set? How many appendices did you take out? What’s your primary focus? What are the things you do most often?” The assessor will go through every department and conduct an extensive examination of the state of their existing resources, as well as determine what the facilities do not have. This process results in an 18-page report that is reviewed to generate a list of what supplies, and how much of what, will be donated to the facility. Typically, the partner (the facility receiving donations) will convey a general idea of what they would like to receive, but this Needs Assessment provides a much more detailed report of what exactly needs to be included in the shipment. After Project C.U.R.E. develops this suggested summary of donations, they send the summary back to the partner facility, who has 30 days to review it and make any changes that they see fit.
To demonstrate the importance of this Needs Assessment process, Noe shared a story where an assessor asked the partner facility if they had wheelchairs. The partner replied that yes, they do have wheelchairs, but the assessor still asked to see them, as Project C.U.R.E. has a lot of donated wheelchairs, and could potentially provide newer and better ones. The facility partner then brought out “a wooden chair that had castors strapped to the legs. So he had a wheeled chair. He did not have a wheelchair.” The Needs Assessment process not only helps provide a detailed account of what the facility needs, but it also takes down language barriers that may exist between Project C.U.R.E. as a US-based donor, and international facilities.
After a Project C.U.R.E. warehouse receives the summary order, volunteers come help sort and pack the requested equipment and supplies. Volunteer doctors, nurses, and medical personnel serve as the first-line of quality assurance for donated supplies, and those with specialized medical training also volunteer to provide more extensive quality assurance measures. There are also volunteer drivers for transporting shipments, as well as volunteer office workers, who help with administrative tasks (taken from projectcure.org).
In an ideal world, Project C.U.R.E. would be able to come in to any country that requests help, conduct a Needs Assessment, gather the necessary supplies at one of seven distribution centers, and send the shipment over. However, as Project C.U.R.E. has served 135 countries as of April, 2022, they have had to deal with 135 foreign policies on receiving aid from abroad. To do this, Project C.U.R.E. has employees whose role is to work with embassies and President’s offices in order to establish mutually agreed-upon protocols for bringing in aid. Project C.U.R.E. also partners with the United States Agency for International Development (USAID), which is an independent agency of the US federal government, whose mission is to “support partners to become self-reliant and capable of leading their own development journeys” (usaid.gov). Some international governments are very open to receiving assistance from Project C.U.R.E., but others are more hesitant, and some simply refuse, which can be very frustrating for both facilities that contact Project C.U.R.E., and for Project C.U.R.E. themselves. For example, Cheryl Noe shared a story about a Reverend in India who, in a three week period, watched 25 of his ministers die from COVID-19. Noe explains that this Reverend wants a donation container, and that she feels that she could get him one. Noe says that she thinks she “could find funding for people who have a heart towards India. But the Indian government makes it not possible to get medical supplies into India. In the past,” she explains, “some governments have experienced being the recipient of medical waste,” and this has produced such a large distrust of medical aid from outside nations that some countries simply refuse to accept what Project C.U.R.E. offers to donate. Furthermore, countries in the European Union are also generally closed off to receiving aid. However, Project C.U.R.E. has recently been working with the Polish government to go through Poland in order to deliver supplies to Ukraine. In doing so, Project C.U.R.E. must have their containers clearly tagged, and it must be noted in the manifesto that these supplies are not to be delivered to Poland, but to go through them and to Ukraine.
Their recent campaign for rebuilding the healthcare infrastructure in Ukraine has actually been one of Project C.U.R.E.’s major successes. Project C.U.R.E. are currently the only ones who can get supplies into the Ukraine – where the United Nations and other charities have failed, Project C.U.R.E. has had tremendous success. This is because Project C.U.R.E. has been working with Ukraine since 1994, so they already have established the relationships necessary to infiltrate such a beleaguered nation. In the past ten years, Project C.U.R.E. has sent about $20 million worth of donations to Ukraine, and are currently the only ones who can ship directly into the country.
At the Project C.U.R.E. Nashville distribution center, there are currently shipments being put together for Lebanon, Ethiopia, Jamaica, Honduras, Zimbabwe, Guatemala, and three for Tanzania. To determine which distribution center around the country will be responsible for a shipment, administrators determine which requested piece of medical equipment is the hardest to obtain, and allocate the order to whichever facility will have the easiest time getting that piece of equipment. Some locations are more well-developed than others, and Nashville’s location is one of the most developed. Cheryl Noe has played a large role in that – Nashville has a very strong ambassador board, with about 75 people sitting on the board. When she signed on to the Nashville location about two and a half years ago, there was no board. Her goal was to build a strong group of people across all areas, who could help spread Project C.U.R.E.’s message, and bring in a variety of people and resources to volunteer, donate, or simply continue to spread the message. She has been extremely successful in doing so, and her efforts have elevated Nashville’s distribution center tremendously.
In terms of policy modifications, it is difficult to propose general public policy suggestions, as Project C.U.R.E. deals with such a wide variety of nations, all with different governing ideologies and policies. In nations that are hindered by EU guidelines, one suggestion might be working directly with the EU in order to establish a specific exception for Project C.U.R.E. in sending in medical resources. This would allow the governing body to closely examine what it is that Project C.U.R.E. is bringing in, and determine the level of comfort they have with the quality of supplies that Project C.U.R.E. can provide. Additionally, one of the major limiting factors in providing donated medical resources is expiration dates. For example, the FDA requires that resources like gauze have an expiration date. Gauze does not expire, and the packaging that it comes in only has an expiration date because the FDA requires it to. However, in places where bleeding is being stopped with reusable rags that have to be cleaned out after each use, gauze (even past its expiration date) could be very valuable, but some nations won’t accept anything past its expiration date. To combat this, the FDA could change its policies in requiring expiration dates, and devise a different system for goods, like gauze, that don’t really adhere to the dates stamped on to them.
The work being done by Project C.U.R.E. has provided great improvements in health outcomes throughout the world. Project C.U.R.E.’s approach follows the “give a man a fish and he’ll eat for a day, but teach a man to fish and he’ll eat for life” mentality, in that they work to provide supplies that will work to sustain the already existing efforts of under resourced facilities, instead of trying to turn them into something that they are not, and would not be able to sustain. Visit projectcure.org if you are interested in volunteering or donating to this extraordinary humanitarian effort.
Literature and Public Policy 