Reducing Waste, Enhancing Health
Every year, the U.S. health care system discards more than $200 million worth of medical equipment and supplies from operating rooms. As a medical student at the University of California, San Francisco (UCSF), Hemal Kanzaria saw usable supplies and medicines tossed in the trash every day.
Because Kanzaria had roots in the developing world, he knew firsthand that items wasted in the United States could be lifesaving elsewhere. So in 2004, he founded Remedy at UCSF, a student-run organization to “recycle” castoff medical supplies into global aid, and help the environment in the process.
Today, Kanzaria, MD, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2012-2014) in the Department of Emergency Medicine at the University of California, Los Angeles. He continues to advise Remedy at UCSF, and to promote it to other health care institutions as a way to increase students’ global awareness, while assisting underserved communities and reducing medical waste.
As a youngster, Kanzaria visited Kenya, where his father grew up, and India, where his mother was raised. “Being exposed to the overwhelming poverty there motivated me to become a physician,” he says, “and to work on larger issues such as reducing health inequities.” At Brown University he got an undergraduate degree in environmental science, with the goal of “combining my commitment to improving health with environmental sustainability.” During college and medical training, he did research and clinical work in impoverished parts of South Africa, India, Kenya, and Guatemala, where he witnessed “the devastating health consequences communities suffer from preventable illnesses and critical shortages of medical supplies.”
Taken together, those experiences inspired Kanzaria to launch a student group at UCSF modeled after a Yale-New Haven Hospital program called REMEDY (short for Recovered Medical Equipment for the Developing World). Kanzaria and fellow students enlisted nurses and other personnel at the university’s Moffitt-Long Hospital to salvage supplies that had been opened but not used, such as spare gloves and instruments on surgical trays. While U.S. regulations deem such supplies unusable, medical charities eagerly take them to distribute in the developing world. When donated in a socially and ethically responsible manner, Kanzaria says, such equipment can be lifesaving.
His team placed Remedy at UCSF collection bins throughout the hospital. Every week, students made “bin runs” to retrieve donated supplies, then sorted and inventoried them. In the first few years, Kanzaria recalls with a chuckle, “We stored a lot of stuff in my apartment and other students’ garages and basements.” When UCSF medical professionals and students did volunteer missions abroad, they took supplies the host clinic needed, thanks to Remedy. The group distributed the rest of what it collected to nonprofit organizations that specialize in supplying medical relief materials to the developing world.
Nearly a decade after it was founded, Remedy at UCSF has its own storage space on campus, collection bins and collaborators on 17 wards at Moffitt-Long Hospital—and recently expanded its collection rounds to a second hospital in nearby Oakland. In the past four years, the group estimates it has collected more than 26,000 pounds of supplies that have been distributed to more than 70 countries by MedShare, a nonprofit. In the aftermath of the January 2010 earthquake that devastated Haiti, MedShare sent planes to Haiti with shipments of supplies, much of which was collected by Remedy.
During her first year at UCSF medical school, Lily Bloom Muldoon took supplies collected by Remedy on a volunteer trip to Haiti to treat patients during a cholera outbreak. Over the next two years, she took supplies to clinics in southern India and on the western coast of Mexico. Now a fourth-year medical student and the Remedy at UCSF program director, Muldoon says the trips and the group have shown her how “a medical student program in the United States can make a difference in an underserved community.”
Muldoon also says an “important benefit of working with Remedy has been meeting Dr. Kanzaria. His mentorship is making a lasting impact.” In April 2013, Remedy’s work was showcased in the opening plenary session presentation at the Society of General Internal Medicine national conference. The next month, the student group received an award from UCSF’s chancellor for its commitment to environmental sustainability.
Since Kanzaria founded the organization, its faculty supervisor has been UCSF medical professor Sharad Jain, MD. Kanzaria and Jain described the achievements of such a program in an article co-authored for the journal The Lancet: “In addition to improving access to care in recipient institutions, benefits include recovery of usable medical equipment, reduction of procedural excess, decreased disposal costs, increased efficiency in managing supply for operating rooms, and increased awareness among staff about waste and recycling.”
Students Ensure Smooth Transitions
In the article, Kanzaria and Jain acknowledge the inherent challenges of a student-run organization. Medical students turn over yearly, and may struggle to keep up with “bin runs” during exams and vacations. But Remedy has remained sustainable, they write, because of the stable participation of hospital nursing staff, the conscientious transition of responsibilities between medical school classes, and the continued involvement of previous participants. “One of the strongest outcomes, for me, is the ongoing connection of students from prior years to Remedy and its work,” says Jain. “Many of our students remain connected to the organization for many years, including Hemal.”
Kanzaria says that when he started Remedy at UCSF, he was eager to help reduce the disparities he witnessed in the developing world—but as an RWJF Clinical Scholar who is still involved with the program, he is now equally focused on “reducing inefficiency and waste in our own system here.”
“My experiences during the fellowship have helped me realize that a small program like Remedy exists because of large problems in the U.S. health care system,” he says. “My ideal would be that a program like this might not need to exist; that the developing world would not have so many unmet treatment needs, and that the U.S. system would not have such waste and inefficiency. Obviously, we’re far from that—but for now, the program gives students a way to think critically about it.”
During the past six months, Kanzaria has been surveying Remedy’s student participants “to evaluate ways to improve the program, and evaluate the impact the program has had on them. The students definitely appear to have gained from their work with this service-learning program. They feel supported to pursue careers devoted to reducing health care inequities, and their work has proved to them that students can make a real-world difference in health care. Integrating a program like this into medical education may be of some value as we think of how to train the physician-leaders of the future.”
Read The Lancet article about Remedy at UCSF.
Read more about Remedy at UCSF.
Read more about the RWJF Clinical Scholars program.
For an overview of RWJF Scholar and Fellow opportunities, visit www.RWJFLeaders.org.