Wednesday, October 12, 2005

Shipping Methods - Getting it to Mosul

Now lets discuss the mechanics of getting stuff to Mosul.

Several commercial carriers take stuff to Iraq, but as far as I know only FedEx carries stuff to civilian addresses in Mosul at this time. Others tend to serve only US military addresses because of the security situation.

Many chemotherapy drugs need to be refrigerated. Exposure to the daytime temperatures in Iraq (up to ~120F) could seriously impact their shelf life or even render them useless. In the USA, such drugs are normally shipped packed with ice in insulated packages via overnight "next day air" fast carriers like FedEx.

In Iraq's current turmoil, overnight shipments to civilian addresses like the hospital are simply not practical, even via FedEx. FedEx shipments to civilian addresses in Mosul including the hospital travel seem to travel by land from Baghdad to Mosul and have sometimes been turned back by security roadblocks between the two cities. FedEx transit time from US and European origins to Mosul in 2005 have been between 11 to 23 days.

FedEx service to US military destinations in Mosul is separate and distinct from service to civilian addresses. The Mosul airport is under currently US military control . FedEx shipments to military personnel and civilian contractors in Mosul travel via air from Dubai to Mosul, and transit times to Mosul from US shipping origins can be less than 3 days. FedEx does not provide service from US controlled areas at or near Mosul airport to civilian addresses in Mosul. However, shipments delivered to Mosul airport can be picked up by a vehicle sent by the hospital or transferred by other means to the hospital. Because shipping chemotherapy drugs packed in ice requires minimizing transit time, it has been necessary to develop and utilize contacts with personnel at the airport.

FedEx uses an associate shipping company, Falcon Express Inc., to deliver shipments to destinations in Iraq, Jordan, Lebanon, Qatar, Syria and Yemen (see FedEx press release). FedEx shipments to Iraq seem to be routed through Dubai, and Falcon Express contacts in Dubai have been very helpful in ensuring that shipments of chemotherapy drugs are protected from the extreme heat of the Middle East during any layovers there and expediting shipments.

In summary, FedEx and it's associate company Falcon Express have proved capable of delivering chemotherapy drugs to Mosul, and methods have been established for getting shipments of drugs packed in ice to refrigeration Mosul within a workable transit time when the drugs require refrigeration.

This seems kind of dry and boring and unexciting, even simple, until you have been involved in it personally and understood the sincere concern of a rather large group of people working together to hurry a shipment of lifesaving drugs to it's destination safely. I count more than 100 email messages related to the last shipment, and I know the sincerity in the hearts of all involved.

Monday, October 10, 2005

Ameristat's website

Here is a link to Ameristat's website. Ameristat is the company that has shipped the chemotherapy drugs I have sent so far to Mosul.

The Great Pharmacy Search

Lets try to flesh out the mechanics of how to send chemotherapy drugs to Iraq.

I'm just a retired engineer, not a doctor or pharmacist or medical professional of any sort, so I had to do quite a bit of learning and searching to figure out how to do it. I asked a LOT of dumb questions a LOT of places. It took weeks and weeks. Eventually I got it figured out and did it. Here's a recap of what I learned.

Chemotherapy drugs are typically only administered in a hospital setting and not prescribed directly to patients. Even then, the typical physician never uses them, only specialist oncologists. They typically have a list of "side effects" warnings that rivals the warnings packaged with Colt handguns: "You risk INJURY OR DEATH by handling this weapon." If they are spilled, the instructions call for treating the event as a hazardous waste spill. They are nothing to play with, strictly very specialized poisons for waging war on cancer.

The typical pharmacy does not carry these drugs for the above reasons. Similarly, no physician in his right mind would normally write anyone a prescription for them to be filled at the local pharmacy.

With this in mind it will come as no surprise that I was able to obtain nothing but a few price quotes from the nice, but rather bemused, pharmacist at my local Wallmart.

I next tried asking for advice at the pharmacy of the Kaiser Permanente Hospital in South Sacramento, presenting them with a written statement of what I was trying to do. The pharmacy was unable to help, but they referred me to the hospital's patient assistance staff and I got a chance to talk the problem over with a rather knowledgeable and very helpful lady there. She advised me that retail pharmacies are normally licensed only to dispense drugs to specific individuals based on doctors' prescriptions, and that their licenses simply do not permit things like shipping crates full of stuff hospitals. What I needed, she informed me, was a wholesale pharmacy!

I therefore began searching for wholesale pharmacies on the internet. I found a pretty good list of pharmaceuticals wholesalers and distributors here: Link . I followed links from that site, looked over the various websites, and eventually came up with a list of 10 outfits that looked like they might sell what was needed and were located in the USA (mostly because outfits in the USA usually have toll-free 800 numbers but also because payment arrangements and legal recourse are MUCH easier with stateside companies).

I sent emails to the 10 candidate companies explaining what I needed, what I was trying to do, asking whether they shipped internationally, and requesting unit price quotes on a list of chemotherapy drugs. Most of my emails went un-answered, so I followed up with telephone calls. This took a couple weeks and the list got shorter and shorter as I crossed off outfits that didn't ship internationally, didn't carry chemotherapy drugs, etc, etc, etc. Finally it was down to a couple outfits in Florida and an outfit called Ameristat in Minneapolis. Eventually I concluded that Ameristat was the best choice. The outfits in Florida were less responsive and seemed to be bound by Florida regulations that complicated matters unnecessarily, while Ameristat was responsive and cooperative and had previous experience shipping chemotherapy drugs to the middle east.

Sunday, October 09, 2005

This is a picture of the hospital in Mosul. I have no idea who the folks in the photo are.

Chemotherapy drugs for Mosul

I think I need to use this blog more actively to report the status and progress of the project I've been working on to get chemotherapy drugs to the Mosul Oncology and Nuclear Medicine Hospital. I have never been much of a journal writer and in my lifetime I have never successfully kept a daily diary, but blogging is a bit different in that there is no requirement for daily entries and a blog can serve as a channel for communication with the world.

I'll just include a brief summary in this first post on the topic.

Iraq is in turmoil, Mosul is in turmoil and this turmoil is affecting the medical system. As I understand it, the Mosul oncology and Nuclear Medicine Hospital is an Iraqi government hospital which provides care for cancer patients in the Mosul area.

Like all Iraqi government hospitals, it depends on an Iraqi government agency called Kimadia to provide it with drugs and supplies, including the chemotherapy drugs used to treat cancer patients. Kimadia has failed to provide everything the hospital needs, although it has managed to at least partially fill some of the hospital's requisitions. The result is that the hospital does not have everything it needs to treat cancer patients.

Some time back I took it upon myself to try to help the hospital get the chemotherapy drugs it needs. A Mosul blogger called "Truth Teller" put me in touch with a contact at the hospital, and that contact provided me with a list of what the hospital had requisitioned and what had been received, and with a prioritized list of what was most urgently needed.

Armed with this "shopping list" I proceeded to try to figure out how to obtain what was needed and what it would cost. Common sense told me from the beginning that I could not possibly hope to completely fill the hospital's needs by myself. However, I felt that if I could find a way to get the hospital at least part of what it needed, the things I learned in doing so would help others do the same.

Over a period of months I have managed to work out methods of ordering the drugs that are needed and arranging their delivery to the hospital. One order has reached the hospital, and another is currently in transit.

Some of the details of this effort must remain confidential because of the turmoil in Iraq - to reveal someone's identity could brand him or her as a "collaborator" in the eyes of some people and place that person in danger. I will try to discuss what I can of the problems I encountered and the solutions I found in future posts.

For the moment, let me simply say that chemotherapy drugs are not cheap. What I have been able to send has helped some people, but is only a tiny part of what the hospital needs. At this point I am forced more and more to the conclusion that I must work to enlist the help of others in this project.