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ACH YEAR, OPERATING ROOMS IN U.S.hospitals throw away about 2,000 tons of per-fectly good medical equipment and supplies,muchof it unused. And that’s just from the ORs, whichcontribute only a fraction of the total waste streamthat pours out of our medical facilities.Hazardous—or “red bag”—waste goes into incinerators, whereit spews out cancer-causing dioxin and other toxicsubstances.The remainder is dumped in landfills.

In 1989, a Pittsburgh woman named KathleenHower,who had worked for several years in hospital administration,cameto the perfectly reasonable conclusion that this was absurd, a reflection ofthe perverse logic of the American health care system. In a litigious soci-ety, hospitals are hostage to their fears of liability; hold on to one itemthat’s a day past its expiration date, and if something goes wrong (re-gardless of whether that item was to blame) you’re likely to find your-self facing a crippling lawsuit. Cognizant of this, manufacturers stampitems with conservative use-by dates, reinforcing a culture of built-in

obsolescence. Companies compete furiously for lucrative hospital con-tracts, and Hower had seen firsthand that when a supplier is changed,everything from the old supplier—everything—must be junked. Parts forequipment are not interchangeable; service contracts lapse.

The result is a gratuitous environmental problem as well as a majorreason for the soaring cost of health care in this country. “That’s themonster we’ve created,” Hower laments. Her response was to create anorganization called Global Links, whose philosophy is both pragmaticand visionary.“We’re a small group, and we’re not going to change theU.S. medical system,”she acknowledges,“but we can make what’s a prob-lem here into a solution there.”

By there she means the developing world—starting with Central Amer-ica and the Caribbean, expanding into other parts of Latin America, andnow reaching Africa and Asia, too. Global Links is sending the simplestof medical supplies—discarded but unused sutures—to places as remote

WASTE NOT WANT NOTAMERICAN HOSPITALS ARE CHARTER MEMBERS OF OUR THROWAWAYSOCIETY. HOW ONE SMALL ORGANIZATION BUCKS THE SYSTEM—AND SAVES LIVESPHOTO-ESSAY BY LYNN JOHNSON

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[2] A combined emergency room/operating room/delivery roomat the University Hospital in the Haitian capital of Port-au-Prince.“It’s like practicing battlefield medicine,” a doctor laments as hiscolleague fights to stitch up (without anesthetic) a woman suf-fering an internal hemorrhage. The brain drain among doctors inthe developing world is not just about money, Kathleen Howersays. It also reflects the demoralizing effect of losing patientsneedlessly for want of basic materials.

[1] In a Pittsburgh emergency room,under bright lights, some of the thingsan American surgeon takes for granted:full-body scrubs, face mask with eye pro-tection, sterile gloves for each newprocedure, forceps, retractors for clamp-ing tissue, electrical cauterizing device,IV pole, anesthesia equipment.

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as Nepal, Madagascar, and Papua New Guinea. Intensive-care beds aregoing to injured civilians in Afghanistan—the “collateral damage”of war.

The first Global Links project was in Nicaragua, beginning in 1990.Other countries in the region quickly followed—including Cuba in 1994,Haiti in 1996,and the Dominican Republic in 1998.From the outset,Howerrecognized that indiscriminate generosity tends to create more problemsthan it solves; the worst mistake an organization of this sort can make isto bombard its beneficiaries with unasked-for gifts that don’t correspondto their specific needs, and those may be quite different from one coun-try to the next.Cuba, for instance,may ask for high-tech items such as car-diac catheters or equipment for kidney dialysis; Haiti, meanwhile, may becrying out for rudimentary infrastructure—chairs, tables,beds,mattresses,filing cabinets for medical records.But whatever they’re after,all of it floodsout of American hospitals in a never-ending stream. “I like to call it sur-plus, not waste,” Hower says.“It’s only waste if you throw it away.”

Seventeen hospitals in western Pennsylvania and West Virginia nowtake part in the Global Links program. The region has an unusual num-ber of medical facilities as well as several pharmaceutical and medical-supply companies, yet there’s no reason in principle why a project of thiskind shouldn’t thrive in any number of U.S. cities.

Of course, the transfer of supplies from here to there is a compli-cated affair. Within each participating hospital, skilled volunteers work-ing in high-pressure conditions must intercept the stuff in the criticalmoments before it’s yanked off the shelves and sent to the dump. Afterthe weekly pickup, other teams of volunteers in the Global Links officeand warehouse must sort the wheat from the chaff. Chaotic heaps ofsyringes and specimen cups, catheters and tracheotomy tubes, epiduralneedles and surgical gowns, must all be sorted and classified by spe-cialty—respiratory, urology, anesthesia, ob-gyn, and so forth—and thensubdivided by item, by expiration date, by sterile versus nonsterile, beforeeventually being packed into 40-foot containers for shipping. Hower andher seven-person staff (plus another seven part-timers) must then workwith hospitals in each country, as well as with regional bodies like thePan-American Health Organization, to make the right match betweensupply and demand.

For the last six years, the renowned photojournalist Lynn Johnson,whosework has graced National Geographic, Newsweek, and many other publi-cations, has been documenting the organization’s activities. Hower andJohnson are both Pittsburgh natives—in fact,they live only a few blocks apart—but they hadnever met until Johnson brought in a team ofstudent photographers to work on a projectabout the activities of Global Links in the Do-minican Republic. Now Johnson, who travelsconstantly,makes time to join Hower in the fieldat least once or twice a year.

The two women share a similar philosophy.You could sum it up in the famous yet never-clichéd line of Margaret Mead’s that is taped toa wall in the Global Links office: “Never doubtthat a small group of thoughtful,committed cit-izens can change the world; indeed, it’s theonly thing that ever has.” —GEORGE BLACK

[3] Cuba’s relatively developed healthcare system can make use of high-techequipment such as kidney dialysis tub-ing (bottom left) and ultrasound mon-itors (bottom right). But more traditionalmethods are also used: This womanrelies on a stick to beat air bubblesout of dialysis tubes.

SEE MORE OF LYNN JOHNSON’SPHOTOGRAPHS OF GLOBALLINKS at www.onearth.org/podcasts

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[5] Since 1994, Hower’s group has sentmore than 70 shipping containers of med-ical supplies to Cuba under a humani-tarian exemption to the U.S. trade embargo.Even so, the embargo continues to barthe transfer of many items, includingX-ray equipment, computers, incubators,and even Petri dishes.

[4] Under portraits of Fidel Castro andhis brother Raúl, Hower meets with Cubanhealth officials to assess their most ur-gent needs. Just before the Cuban leader’srecent illness, Hower joined him for atypical Castro-length meeting: eighthours, ending at 5:30 in the morning.

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[7] A child from the slums of Cité Soleil waits for atten-tion in the pediatric intensive care unit of Haiti’s Univer-sity Hospital. The poorest section of Port-au-Prince, CitéSoleil is home to about 200,000 people.

[6] In mid-delivery, a Dominican woman is moved fromone bed to another by a nurse and a relative. No gurney,no wheelchair, no hospital gown, not even sheets on thebed. Maternal and infant mortality levels are a criticalproblem in the Dominican Republic.

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[8] Volunteers from local churches,schools and colleges, Boy Scout andGirl Scout troops, and Pittsburgh-areacorporations such as U.S. Airways con-tribute 500 hours or more each monthto sort supplies. Many say that work-ing for Global Links is a singularly re-warding activity, since they have directevidence that their work is saving lives.

[9] Haitian hospitals are so impoverishedthat patients must often go to the pharmacyto buy their own supplies before doctors cantreat them. Donations of even the simplestitems—like a thermometer—are welcomed.

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