Statement 6: No Double Standards. Today we want to affirm that when doing healthcare in an international setting it is essential not to compromise our standards. We should not accept any hint of a double standard in the work we do. What do we mean? 

    • Give medications in a health-care setting: (Promote preventive practices, attitudes and behavior before or at the time of giving medications) (one could argue that a church is a health-care setting or should be)

    • In-country local primary health care provider who knows the patient and the culture should prescribe the medications.

    • No experimental medications

    • No expired medications. I think we can all agree on this one. But when it comes to not yet expired medications there is some flexibility. For example there is the 

    • WHO GUIDELINE FOR DRUG DONATION:

After arrival in the recipient country all donated drugs should have a remaining shelf-life of at least one year.

Most are aware of the severe shortage of medications that most clinic’s/hospital’s in developing nations experience on a nearly day to day basis. Medications that are brought legally into another country will likely be used up very quickly and we believe flexibility in this WHO standard is appropriate so long as it is assured that the leftover medications are left with a licensed professional who is able to monitor the use and distribution of the medications.

 

  • Safe distribution of medications

    • Child-safe

    • Labeled

    • WHO essential medications

  • Purchase medications in country – this is obviously a hot button topic since so many are now using medications received from foundations and individuals who really want to do good for those suffering from a lack of access to affordable medications. But by bypassing the local system we allow for the perpetuation of a local system that is not meeting the need. Also by buying in country we can help stimulate the local economy. Local purchases would of course need to be made with reputable sources and assurances as to the quality would need to be made.

  • We support the Core Principles of the WHO guidelines on donated drugs:

    1. Maximum benefit to the recipient
    2. Respect for wishes and authority of the recipient
    3. No double standards in quality
    4. Effective communication between donor and recipient
  • No drugs should be donated that have been issued to patients and then returned to a pharmacy or elsewhere, or were given to health professionals as free samples.
  • Sit side by side with the local physician who is prescribing medications.

  • Make sure to obtain an adequate history with medication allergies, a good examination and any laboratory or imaging studies as needed

  • Give important information about the medication to the patient

    • Labeled in the local language – medication, dose, and prescription.

    • What the medication does and what to do if the medication does not work.

    • Discuss adverse effects of medications

    • Site for follow-up

    • Risks associated with overdose

  • We will obtain informed consent for any anything that we do for people including prescribed medications.
  • We will keep accurate and accessible medical records and make arrangements for their long-term local maintenance.
  • We will correctly utilize interpreters so that the people understand health information and what we are doing on their behalf and what they can do to stay healthy.
Greetings once again from the Zeal With Knowledge blog, a ministry of the Best Practices in Global Health Missions group and the Health for All Nations. This posting is going to make a slight diversion from the vision360 video series and will focus on an important topic that has come up in some recent discussions stemming from a presentation by Dr Peter Yorgin at the recent National Short Term Missions conference in Tucson.In his excellent presentation Dr Yorgin builds on the  7 Standards of Excellence  as developed and promoted by the ministry of the same name. (see SOE) An important point made has to do with medications which are brought in from outside the host country and which the STMM team will be passing out to the patients they see during their stay. Most countries have laws on the books pertaining to this practice and to the best of my knowledge most require that the incoming meds be not less than one year from their date of expiration. If that is the case can we then justify bringing in medications whose date of expiration is less than what the law permits? We have had some feedback on this question already and there are points to be made from both those who think its OK and those who think we should follow the laws that govern the nations in which we are working.

Here is one comment made by a good friend of the Health for All Nations, “

For medicines… one year shelf life really isn`t realistic especially if bringing in small quantities.. I would tend to say 3-6 months would be ok if plan to use during the visit or shortly after.” I know this is consistent with the way the majority approach this question. But it is the right approach? Here is another quote from someone who is involved in frequent STMM’s, “Some items in the slides (referring to Dr Yorgin’s PowerPoint), like requiring the meds to have at least one year before expiration, do not seem reasonable to me. We only give out small supplies of meds to each person, and never take expired meds, and never take meds which have been issued to other people, but requiring meds to have at least one year before expiration means we can’t use our resources wisely to get discounted meds that are due to expire in 3-4 months. I almost always take these discounted meds on my trips. Of course, a team could always make this their own requirement if the Medical Team Leader felt strongly about it and had the resources.”An important point that needs to be made is that all such STMM’s are going to be operating within a context where there are LAWS that are supposed to govern the actions of people who not only live in that country but who come from outside the host country to work and do good things for people who are suffering and disadvantaged. And we all are aware of the high levels of corruption that exists in most of these countries. And we are quick to criticize such corruption and other breaches of the law but we don’t seem to have a problem with breaking the law when it comes to this point about expiration dates on meds. What signal  does that send to those we are going to work with and to those who are supposed to be upholding the laws of the land? As Christians are we not called to set the bar at the highest level when it comes to how we carry out our work in foreign countries? Our standards must be such that they meet or preferably exceed those which the world (in this case secular governments) has set for itself. 1 Peter 2: 13-15 says “ Therefore submit yourselves to every  ordinance of man for the Lord’s sake, whether to the king as supreme, or to governors, as to those who are sent by him for the punishment of evildoers and for the praise of those who do good. For this is the will of God, that by doing good you may put to silence the ignorance of foolish men –

One argument made is that purchasing meds in country is too risky in that we cannot always count on the quality being what we think it should be. If that is the case then shouldn’t we discuss this with our in country partners and figure out how we can help assure that in country meds are of an acceptable quality? Is it not possible that in doing so we help establish services in country that test meds and assure that acceptable standards exist and are being enforced? Wouldn’t this help elevate the level of healthcare for all in that country?

What then can be done with all the meds that are still good though they are say within 3-6 months of their expiration date? My first thought centers on pharmaceuticals produced in the US. Would it not be better that these meds be given to health clinics serving the nations poor? If this is not happening, why not? Surely there are sufficient needs in the inner cities of most every state in the US.

But let’s say we want to continue using such meds on STMM’s. Would  it not make sense to have our in country partners contact and work with the in country authorities to gain approval of the use of such meds on a short term basis? That way we would show respect for the law and for the authority of these governmental workers. What a witness we could be. And would it not be a good thing to make at least a portion of what we bring in available to those who work in very difficult situations in governmental hospitals and clinics? Again, in doing so we would be a strong and effective witness to an unbelieving world. We welcome your feedback and comments. Also check out this excellent source online: http://www.cpfi.org/assets/docs/c-and-p/cp_2011v14_1_p6-11.pdf