Mosul Chemotherapy Project (was "waldschrat's mirror")

Update

2011-11-23T17:16:00.000-08:00

I yet live.

I have updated my profile and need to do other blog maintenance when I find time but not today, I am too busy preparing for Thanksgiving Day tomorrow.

Day by day

2010-06-05T03:37:00.000-07:00

I yet live. but congestive heart failure is an aggravation and my energy level is pretty low.

I follow the Mosul news off and on, what there is of it. Every indication is it's still a pretty dangerous place but maybe there are fewer mindless bombs and killings. Perhaps there are simply fewer reports of such but one can hope.

Project Status

2009-12-09T08:39:00.000-08:00

I yet live.

Spammers have been dropping pseudocomments on the most recent post, with links back to their own commercial sites, so I have disabled comments for non-members, me being the only member.

I can be reached via the contact info at the top of the page.

The Mosul Chemotherapy Project is inactive until further notice. My contacts at Mosul Oncology and Nuclear Medicine Hospital informed me some time ago that supplies arriving through normal Iraqi channels (Ministry of Health, Kimadia, etc) have improved to the point that costs and risks associated with shipments delivered by this project are no longer justified. I will continue to monitor the situation intermittently as best I can (reading news reports, occaisional phone calls to Mosul, etc.) and attempt to renew my efforts if asked.

I think I have mentioned before that I count as heroes all those who helped in this project. This includes Iraqi doctors, American personnel stationed near Mosul Airport, FedEx people who expedited shipments, pharmacists who dispatched the many difficult shipments, folks who chipped in to help pay for them, etc. In most cases I have not mentioned their names to avoid exposing folks in Mosul to added risk and out of respect for their privacy. One guy, Brad Blauser, a civilian contractor, took the "hero" thing so far in so many ways that others noticed and he wound up on nationwide TV when CNN gave recognition to a "Heroes Top Ten" recently (YouTube CNN video). Check out the big grin on Brad's face in Brad's own video as he helps a disabled Iraqi kid who's just received a fancy pediatric wheelchair due in large part to Brad's efforts. I have never met the folks I've worked with in this project face-to-face, and probably never will, but I've sensed in them the same kind of satisfaction at doing something helpful and worthwhile that you can see on Brad's face. I am enormously grateful to have had the chance to work with them.

Events in April and May

2008-05-26T23:20:00.000-07:00

I got confirmation from my contact at the hospital that the latest shipment of drugs from India reached the hospital last week. Again, the shipment contained 50 vials of doxorubicin and 10 vials of carboplatin as before.

When I spoke to my contact, he indicated that oncologists at the hospital have become dubious of the quality of the drugs in recent shipments based on apparent response of patients to treatment. Because of the poor phone connection I was unable to understand all the details and I have asked him for clarification.

The chemotherapy drugs in recent shipments have been produced in India and shipped from there. I was very careful to investigate the competency and quality control program of the supplier in India before deciding to work with them, and I have good reason to believe they are competent and well equipped to properly test and verify the quality of their products. I have asked them to provide analytical reports for the drugs delivered in recent shipments. Hopefully, such data will enable the specialists at the hospital in Mosul to make a well informed assessment of the drugs and decide whether to continue using them.

I am not sure but I suspect there may be a general suspicion of all imported drugs among Iraqi doctors. I think perhaps I need to caution the people at the hospital that there is strong reason to believe that the drugs from the Indian supplier are full strength and exactly as labeled, and that it could be unsafe to assume otherwise when administering them.

On another subject, in April there was an event dubbed a "Global Activism Expo" in Chicago sponsored by Chicago Public Radio. Here is a Link. Mr. Robert Braam attended to represent the Mosul Chemotherapy Project, and several hundred people had an opportunity to look at flyers about the project. There has so far been little that has come of it in email or comments on this blog, but perhaps someone who took home a flyer will pass it along. If you'd like to look at a PDF version of the flyer, you can find a copy by following this Link.

Update - Crediting Kimadia with SOME Improvement

2008-03-31T11:23:00.000-07:00

I spoke to my contact at the hospital today about the continuing supply problems, and he indicated that although the shortage of chemotherapy drugs from Kimadia is still critical and near-total, there have in fact been some improvements over the last year in deliveries of other supplies. One example he mentioned was a recent rather large delivery of ostomy supplies. Another was improvement in delivery of surgical supplies including such things as dressings, anesthetics and antibiotics, to the extent that the number of surgeries per week per surgeon which is possible with the available supplies has approximately doubled in the last year.

I asked whether the supply problems seem attributable to corruption or to shortage of funds or some other cause. His feeling seemed to be that it is the general chaos that afflicts Iraq that is the most important problem. He seemed doubtful that highly placed people in the Ministry of Health were diverting supplies to the black market but considered it possible that lower echelon personnel might do so if the opportunity presented itself.

I have never ceased to be impressed by the dedication and courage of Iraq's doctors, and to the extent that the Ministry of Health is staffed by physicians I have no doubt that the welfare of the patients of Iraq is their primary concern.

March Shipment

2008-03-30T03:59:00.000-07:00

I got confirmation from the hospital that the latest shipment arrived there OK on March 23, 2008.

The shipment included:

1. Doxorubicin 50 mg vials : 50 vials
2. Carboplatin 450 mg vials : 10 vials

USA Today Article Blames Sadr

2008-03-29T21:52:00.000-07:00

A recent USA Today article titled "Sadrists' grip on Iraqis' health care takes toll" indicates that Sadr and his cronies control the Ministry of Health and it's Kimadia agency and use them as a tool to exercise power. The presence of a large portrait of Sadr's relatives outside the Ministry offices is offered as confirming evidence.

In part, the article says:
Al-Sadr's control over Kimadia, the state-run company that is responsible for importing and distributing drugs and supplies to Iraq's hospitals, also poses problems, Ferrati said.

"Kimadia has a stranglehold on the whole medical sector, and that is a source of power through which Sadr can control the health sector and threaten the country," Ferrati said. "If they decide to stop working, then you cut off all the drugs into Iraq."

This is interesting because it suggests a face or group identity to blame for the supply woes afflicting Iraq's hospitals, but I suspect it might be erroneous or oversimplified. If I had to guess I would say not all of the Health Ministry is corrupt although serious corruption would be consistent with the poor job Kimadia seems to be doing; Kimadia's personnel in Mosul seem to have the respect of my contacts there although they are far from satisfied with the job Kimadia is doing. I suspect many Ministry and Kimadia people are honest enough and if there are miscreants they are probably a minority, possibly in management positions if they are in fact Sadr's politically appointed agents. Also, I have seen no indication that the medical supply situation is better in any particular place in Iraq than others, suggesting that rather than withholding medical supplies from some parts of Iraq that don't toe Sadr's line and providing them to other areas that do, necessary supplies are being denied to (or stolen from) all without prejudice. This would be more consistent with diverting medical supplies for profit and using the proceeds to finance criminal/sectarian activities than bartering the supplies for favors. That would match reported profiteering on diverted oil in southern Iraq where militis are reportedly heavily involved it that corrupt trading problem. If medical supplies and drugs are being diverted for profit, it's presumably happening in Baghdad and involves collaboration of militias.

Of course I'm half a world away and have no direct knowledge of any of this, but something pretty outrageous is causing serious problems for Iraq's hospitals.

Another Delivery

2008-03-02T23:33:00.000-08:00

I got confirmation February 26th that the most recent shipment was received at the hospital OK. The shipment included the following:

1. Doxorubicin 50 mg vials : 51 vials
2. Carboplatin 450 mg vials : 10 vials

An intensive effort by the supplier to upgrade packaging procedures was effective, based on photos of the shipment and it's preparation, and all the vials arrived intact.

In addition to the chemotherapy drugs, the supplier also sent a separate shipment containing some samples of broad spectrum antibiotics intended to combat infections in patients with immune systems compromised by chemotherapy. They have indicated a willingness to provide additional supplies if the hospital finds the samples effective. The antibiotics arrived at Mosul Airport without advance notice a few days after the chemo drugs, and it was not possible to transfer them to the hospital at the same time as the chemo drugs.

Another shipment of chemo drugs has been ordered and will hopefully reach the hospital in March.

This project has been delivering chemotherapy drugs to Mosul Oncology and Nuclear Medicine Hospital on a more or less regular basis since August 2005. Regrettably, I have never managed to attract major funding or support for the project. The shipments are funded mainly out of my own pocket, and my resources are not sufficient to do more than demonstrate that delivery of shipments is possible.

I can never hope to provide enough supplies to resolve the severe shortages afflicting the hospital. Little evidence has materialized to indicate that the Iraqi Ministry of Health and it's purchasing arm, "Kimadia", can be soon expected to properly provide adequate supplies to Mosul's hospitals or to any of Iraq's hospitals.

The inevitable result is that people are dying who would not die if the Ministry of Health and Kimadia did their job and supplied Iraq's hospitals properly and effectively. The shortages of necessary supplies at Iraq's hospitals are lethal to the patients who depend of the Ministry of Health system for care, despite the best efforts of Iraq's doctors to deliver care in the face of continuous desperate shortages. I have no idea how many lost lives can be attributed to the failure of the Ministry of Health and Kimadia to properly supply Iraq's hospitals, but I believe the numbers must inevitably be huge, comparable to the number of lives lost to violence if not larger.

The outrageous supply shortages in Iraq's hospitals are not frequently mentioned in the news, but they exist with total certainty and they are nationwide. Every news report, however brief and however un-noticed, attests to their severity. Nothing is heard to indicate that the nationwide tragedy of neglect afflicting Iraq's hospitals is some mere figment. The plight of Iraq's hospitals is clear to anyone who has the interest to open their eyes and investigate.

I have tried to avoid speaking ill of Kimadia and the Ministry of Health, because I am a half a world away and I have no way of knowing with certainty exactly what is causing the shortages afflicting Iraq's hospitals. However, whatever the cause, and whoever is responsible, the shortages are real, and they are lethal to the patients of Iraq, and those responsible for supplying Iraq's hospitals have failed to do so. To keep silent about the problem is no longer reasonable.

Recent Deliveries

2008-01-12T21:58:00.000-08:00

I have been remiss in logging recent deliveries.

A shipment reached the hospital on 11/22/07 or thereabouts - I got confirmation by telephone sometime on 11/21, I think, and sent an email that phone call on 11/22. Unlike the FedEx tracking info that documents shipment locations and times enroute to the airport, transport to the to the hospital is accopmplished by busy people by methods and on schedules which can not be reported or discussed for security reasons - nobody takes notes, they just get the lifesaving drugs where they need to go and send me an email that they did so.

This shipment included 50 vials Doxorubicin (50 mg/25 ml) and 8 intact vials Carboplatin (450 mg/45ml) (2 were lost by breakage in transit from India)

A shipment reached Mosul Airport January 9th and is safely stored under refrigeration there pending arrangements to transport it to the hospital.

This shipment in progress includes 49 intact vials Doxorubicin(50mg/25ml) (1 was broken in transit from India) and 12 vials Carboplatin(45mg/45ml).

The breakage of vials in transit in the last two shipments is being energetically investigated and an effective correction of the problem is hoped for soon. No breakage has occurred in the many shipments which preceded these. These drugs are potent and potentially hazardous if spilled, and standard procedure in the event of a spill is to wear protective gloves and safety glasses, wipe up all spilled liquid, and wash the area. All cleaning materials and waste including the gloves need to be bagged up and either buried or burned. The vials come each in it's own individual carton, and any contaminated cartons have to be discarded with the other cleanup materials.

I have checked with FedEx representatives and there is no obvious cause for the recent breakage in transit other than problems in how the shipments are packaged for shipment. I made it clear to the supplier after the first incident that the shipments needed to be packaged better, and we agreed that they would be. Now that there has been a second incident, my understanding is that high level management will be watching and taking photos as the next shipment is packed to ensure that everything possible is being done to prevent further breakage in transit.

Stalled

2007-12-30T11:27:00.000-08:00

Although it was my hope to get two shipments to Mosul during December it has so far been impossible to get the drugs shipped from India. I am not completely sure what the cause is. A phone call today brought news that the goods are now available and may hopefully be shipped this week.

Recent Events

2007-10-08T11:09:00.000-07:00

I have never been much at keeping diaries and journals, and am much better at procrastinating than keeping any schedule. Let me try to recap the events of the last month or so.

I got an email September 4th from my contact at the hospital reporting a delivery by the Iraqi agency Kimadia as follows:

The hospital received in August the following drugs from KIMADIA:
1.Actinmycin vial : 281
2.Doxorubicin 50 mg vial : 427
3.Mitomycin 10 mg vial : 200
4. Vincristine 1 mg vial : 1000
5. Interferon 9 m units vial : 1500

The quantities are much larger than the shipments I am able to send, but this is the first shipment of chemo drugs of any importance received from Kimadia in about a year, so far as I know. Although the shipment from Kimadia was gratefully received it is less than the hospital's needs by far. It remains to be seen whether Kimadia can establish a regular pattern of deliveries.

My contact said on the phone that an additional small shipment (2 or 3 vials of doxorubicin and about 50 vials of vincristine) was received from Kimadia in September. I have difficulty hearing him clearly on the phone and his email service remains intermittent so I'm not 100% percet sure of the details of this small shipment.

On a less encouraging note, I noticed a story from an Iraqi news agency indicating that Syrian police in Damascus recently confiscated "more than 60,000 packets of drugs" with a value "estimated at $16 million" originally purchased by the Iraqi government smuggled out of Iraq for sale elsewhere. The story I read is here: LINK . I looked for confirmation from other news services but couldn't find any. Never the less, the report is distressing and is consistent with the pattern of shortages at Iraqi hospitals.

I was able to arrange a shipment to the hospital in September from the supplier I am currently working with in India. The were a few glitches but the shipment reached the hospital OK. Problems included unexpectedly long transit time as indicated by FedEx tracking. A helper unexpectedly went on leave at the Mosul Airport, and friction developed among other helpers there trying to improvise in his absence. The shipment was kept un-opened in a fridge overnight (actually, spare space in 3 hastily commandeered fridges) while one helper tracked down the other, so it's not 100% clear what the condition of the icepacks was on arrival at the airport. My guess is the drugs were at above optimum storage temperatures for 1 to 3 days and should not have deteriorated substantially, but I am not a medical person. About all I could do was report the long transit time etc to the hospital and let the oncologists there make the decision on whether the drugs were fit to use. My understanding is that they concluded they were.

This shipment included
1.Carboplatin 450 mg vial : 10 vials
2.Doxorubicin 50 mg vial : 50 vials
and, additionally, 50 vials of vincristine provided as a sample by the vendor.

Shifting Gears

2007-08-29T02:04:00.000-07:00

I have been working with my contact at the hospital to try to configure the next shipment but things are in a state of flux at this point. If I understood correctly over a bad phone connection, the hospital has been notified that some drugs are available from the Ministry of Health / Kimadia in Baghdad but need to be picked up there and hauled somehow to Mosul. My contact's email has been unreliable and the phone leaves me wondering what half his words were so I'm unclear on all the details, but I expect that they will know in a week or so how their supply situation will look in the comoing month. Although collecting the stuff from Baghdad will a potentially dangerous problem for many reasons, the reported availability of anything to collect is a welcome change from the many months when there was nothing coming through the normal supply channel at all.

On another subject, I have annotated the info in the donation instructions to reflect the fact that complications related to staff changes at LIFE need to be worked out before I can say with certainty that donations through LIFE to help the hospital will be possible as they were before. I developed a working relationship with my previous contacts at LIFE that enabled donations from myself and others to pay for a series of shipments to the hospital, with myself doing most of the communications legwork finding how much money was available for each shipment, what the hospital wanted shipped to best help the patients with that money, and coordinating with LIFE, the shipping pharmacy, helpers at Mosul airport and the hospital to get the stuff there. With my old contacts gone, I need to rebuild that working relationship and will try to do so in coming weeks.

2007-08-23T02:24:00.000-07:00

The shipment of doxorubicin (50 50-mg vials) reached the hospital. I have alerted my contact there to the fact that the unexpected delay in Dubai allowed the icepacks to melt in transit; helpers at the airport refroze them before delivery to the hospital. The best info I have is that the drugs were kept in an air conditioned area in Dubai and should not have deteriorated substantially due the delay there. All possible efforts wil be made to avoid similar problems in the future, of course.

Busy again

2007-08-15T12:57:00.000-07:00

A shipment of doxorubicin is in transit, stuck in Dubai for the moment but expected to get to the airport in Mosul in coming days. The flight schedule has changed, apparently, and we will need to schedule shipments differently in the future to mesh with it and keep the transit time to a minimum.

Planning next shipment, hopefully in August

2007-07-31T16:55:00.000-07:00

The Mosul end of the logistics chain has morphed into a different form after six attempts to arrange for the drugs to be picked up at the airport failed, and it may change further in the near future. 24 vials of etoposide reached the hospital, and additional vials, the remainder of the shipment will hopefully get there this week.

I was extremely discouraged by the failure of six attempts to deliver the last shipment from the airport to the hospital, as were the folks who faced the chaos of Iraq to try to make the deliveries happen. Now, with an additional helper at the airport and a new way to get the drugs downtown to the hospital it seems that deliveries are again practical.

As I write this I am struck by the fact that what I feel it is safe to tell is so scanty. The everyday dangers of life in Iraq are inescapeable, and any interaction between Iraqis and people at the fortified airport in Mosul is even more dangerous, regardless of the goodwill of all concerned. I am drawn between the need to convey a reasonable amount of information about the project to anyone who might be willing to help and the need to conceal anything and everything that might place people at risk.

The shortages at the hospital continue. Patients continue to suffer because of them. I continue to try to do everything I can to get shipments of drugs, even though the shipments are pitifully small in comparison to the overall need.

The project continues, in hope that there will be a time that the need is gone.

Project Continues Despite Difficulties

2007-06-23T15:11:00.000-07:00

The shortages of medicines at Iraq's hospitals continue. I came across an article related to the ongoing problem here: link

I continue to do what I can to try to get chemotherapy drugs to the hospital in Mosul but there are difficulties, among them the following:

1. My own financial resources are reduced at the current time, and I have been one of the largest contributors to the project.

2. Communications with LIFE have been difficult recently, apparently due to personnel changes and staffing problems.

3. Contributions from others have been limited, although a new supplier has offered to provide drugs at a very good price, for which I thnk them profusely.

4. Shipping problems developed during May in connection with trial shipments to Mosul of some samples from the new supplier. Although considerable confusion and frustration was encountered in connection with those shipping problems, they provided valuable experience which should help future shipments go more smoothly and the two shipments of samples did finally reach Mosul airport.

5. Problems have developed in arranging transfer of the sample shipments from Mosul Airport to the hospital. Five attempts have failed so far, but the problems seem to have been identified and steps are underway to resolve them.

In summary, what became almost routine last year has become more difficult. Never the less, the project continues. I would rather be reporting delivery of shipments to the hospital than problems. Regretably, I can not.

Another Shipment Reachs the Hospital

2007-02-22T12:53:00.000-08:00

The hospital has confirmed that the first shipment of 2007 reached the hospital this week. The (planned) contents of this shipment were the same as the previous shipment:

- Doxorubicin 50 mg vial : 48 vials planned, 45 actually shipped and received

The confirmation was a bit later than expected and I spent a worried day or two hoping that my contact at the hospital had not become a victim of the endless chaos that afflicts Iraq. Fortunately the cause of the delay turned out to be only the "routine" outages of electricity coupled with the high cost of fuel which has put the local generator off line.

Correction: Although 48 vials was the planned quantity, 45 vials were actually shipped and received. The text above has been corrected accordingly.

Another shipment in the pipeline

2007-02-17T14:39:00.000-08:00

Another shipment of chemotherapy drugs is well on the way and has in fact reached Mosul Airport where the hospital will pick it up in the near future. This shipment was the first funded entirely by others through Life for Relief and Development. My own contributions have necessarily been interrupted in the last couple months while I have been recovering from surgery and paying down my credit card balances.

The plight of Iraq's hospitals including the Mosul Oncology and Nuclear Medicine Hospital remains dire according to all available reports. Supplies, particularly chemotherapy drugs, by Kimadia (the Ministry of Health's purchasing agency) are sparse or nonexistent and unpredictable. A recent news report said a highly placed deputy in the Ministry of Health had been arrested on charges of misdirection of funds and other crimes - guilty or not, it seems his conduct was at best not above suspicion. In the last year I have corresponded with folks working at other hospitals and at with NGO's other than Life for Relief and Development and all never seen anything to indicate that the supply situation of Iraq's hospitals is anything but terrible everywhere.

Yet this project has managed to deliver shipment after shipment to the hospital in Mosul. This project began as a demonstration that shipments CAN be delivered despite all the problems and chaos and danger. Although the problems affecting delivery to other hospitals in other cities would of course be different, I think this project's success so far has in fact managed to demonstrate that.

I am an engineer and it's hard for me to believe that God (by whatever name) plays an active part in everyday affairs, but I know that many of the folks involved in this project feel that an unseen power is perhaps lending a hand or at least smiling as shipment after shipment reaches it's destination safely. I know participating in this project has made me feel good personally, and that others report the same.

I expect to resume my own contributions to the project next month and I hope others will contribute also. Until the Iraqi Ministry of Health can prove to the people of Iraq and the world that it can adequately supply the hospitals of Iraq, there will be a need for this project and I will support it to the extent to which I am able. I encourage others to do likewise.

Status

2007-01-31T00:35:00.000-08:00

My health is on the mend and I am trying to organize the next shipment.

Unanticipated Hiatus

2007-01-15T00:58:00.000-08:00

I am afraid I have become too important to this project, or perhaps never really succeeded in finding others to take up an active role in it. I had a quintuple heart bypass operation the day after Christmas and am in the process of recovering from that surgery. In the absence of help from others I am afraid the earliest the next shipment of chemotherapy drugs can be sent will be next month.

Another shipment delivered

2006-12-15T00:15:00.000-08:00

The hospital confirmed on December 11th that the latest shipment reached them safely. My routine is a bit disrupted lately by recent travels and house guests and other matters so I can not go into great detail. The latest shipment consisted of

- Doxorubicin 50 mg vial : 48 vials

It was difficult organizing the shipment around personnel changes and vacation schedules, and the shipment took an unexpected 2-day detour to Baghdad, but it got there safely.

Shipment recieved at hospital

2006-11-16T16:47:00.000-08:00

I got word from the hospital that the latest shipment got there OK on Nov. 15, 2006. This shipment included:

- Doxorubicin 50 mg vial : 35 vials
- Vincristine 2 mg vial : 48 vials

There was a glitch earlier in the week when an ambulance from the hospital was unable to connect with the folks at the airport to collect the drugs, but it got straightened out OK on the second try.

Now, planning for the next shipment begins.

Another Shipment is On It's Way

2006-11-08T00:28:00.000-08:00

Once again drugs are in the air over the Atlantic.

I was hoping to accelerate the schedule so shipments would arrive closer to the start of the month. Things were a bit rushed in getting the order configured and the funds transferred and there was a minor glitch at the last minute. The order was supposed to include 35 vials of Doxorubicin and 50 vials of Vincristine but only 48 vials of Vincristine could be shipped because Ameristat Pharmaceeuticals exhausted the Vincristine supplies of their wholesale supplier and the tight schedule didn't allow time to get the additional 2 vials from an alternate supplier. The cost of the 2 vials will be refunded and the money will be applied to the next shipment, but the book keeping is more complex than it would have been otherwise.

Another shipment reaches the hospital

2006-10-18T03:32:00.000-07:00

The hospital confirmed that it recieved the latest shipment OK on Monday October 16, 2006. This was the 9th successful shipment, the seventh this year, the fifth in which the funds were handled by the earmarked Mosul Hospital Fund at Life for Relief and Development.

This shipment included the following:
- Doxorubicin 50 mg vial : 35 vials
- Vincristine 2 mg vial : 30 vials

Although I'm still carrying most of the weight as far as funding, it's important that people know that I am not the only one supporting this project. Eight other people have donated to the fund so far, their gifts have ranged from $25 to $500, and some have made multiple donations. I don't know all their names, but I want to present the best accounting I can so they will know their money is going where they intended.

Donations to the Mosul Hospital Fund at Life for Relief and Development so far are as follows:

5/24/2006 - $4400.00
6/5/2006 - $100.00
6/20/2006 - $3750.00
6/22/2006 - $300.00
6/26/2006 - $100.00
7/28/2006 - $3875.00
8/2/2006 - $200.00
8/8/2006 - $200.00
8/23/2006 - $25.00
8/24/2006 - $3,875.00
9/7/2006 - $25.00
9/12/2006 - $100.00
9/29/2006 - $3900.00
10/5/2006 - $20.00
10/5/2006 - $25.00
10/11/2006 - $500.00
TOTAL: $21395.00

These funds have been applied as follows:
$18644.68 (87.15%) Paid so far to Ameristat Pharmaceuticals in Minneapolis for Shipments to Mosul.
$610.82 (2.85%) To be applied to next shipment to Mosul.
$2139.50 (10%) Reserved for LIFE's overhead (office space, accounting, etc).

I ask those who have contributed to not be concerned by the reserve for LIFE's overhead costs. I am adding an amount to my own donations to cover the overhead costs, as well as shipping costs, and all your donations ARE being applied to payments for drugs and nothing but drugs. For instance, I will notify the hospital that $3678.69 will be available for drugs for the next shipment ($3000 from me, $610.82 from others, and $67.87 which I will chip in to offset the overhead reserve associated with that $610.82).

Does it make sense to spend this kind of money, folks? I know for my part it's hard to do. I'd rather plow the rent I'm pulling in from my tenants and my social security check and the insurance settlement that should have gone into body work on my truck into savings and repairs on my own home and maybe even a nice vacation. But if I did that I'd be letting down the folks in Mosul. This project is beginning to eat into my savings this month, but I don't expect to live forever and I'm getting a bigger bang out of this project than anything I ever did. Call it charity, call it waging peace, call it an internet shopping spree that got out of hand, I'm having a blast and doing some good in this world. I extend my thanks to all the folks who have chipped in to support this fine madness.

How it will end I have no idea. Ultimately it can't go on forever. The Iraqi government, the Ministry of Health and Kimadia, are eventually going to have to find a way to deal with whatever it is that's preventing them from properly supplying the hospitals of Iraq. I can't imagine that the people of Iraq will tolerate anything else. It could happen in months, or maybe in years. For the time being, tell everybody you know that there is a desperate shortage of supplies at the hospitals of Iraq, and this project is doing what it can to resolve those shortages.

Drugs Are In The Air (again)

2006-10-10T13:42:00.000-07:00

Once again drugs are in the air on a FedEx plane bound for Mosul. This time sadness weighs on the hearts of some of the folks involved in the project. A Baghdad staff worker for Life for Relief and Development, the organization that handles funds donated to the Mosul Chemotherapy Project, was pointlessly murdered by ignorant thugs who apparently felt that weapons and slaughter are the only available solution to the problems they perceive. A news release describing that sad event will be found here: LINK

Sitting safe in my house in California I am continuously aware of the chaos and violence that engulfs Iraq in these days and the risks people there face. The situation there will not improve until people recognize that weapons and murder are not appropriate tools for the improvement of society. The murder of Abdul-Sattar Abdullah in Baghdad protected no one and improved nothing. There is nothing to indicate that he was anything but a decent man working for the improvement of Iraq. It was a tragic act of ignorance and stupidity. Only a fool could imagine that it served any reasonable purpose or pleased god in any way.

The shipment of chemotherapy drugs that is, as I write, on a plane over the Atlantic ocean will hopefully prolong the lives of the people it is used to treat. Perhaps the courage of the people those drugs benefit will serve as an example to those around them. Perhaps their prayers will please god. Perhaps the love they share with family and friends will inspire others.

Which is better, efforts expended in the ignorant slaughter of the innocent, or efforts expended in hope of improving and extending the life of decent people? I know the answer in my heart with total certainty. I can only hope that those who slaughtered Abdul-Sattar Abdullah in Baghdad learn to recognize it.

I never knew Abdul-Sattar Abdullah or the many others like him who have labored in Iraq to try to improve conditions there, only to be slaughtered by the forces of chaos and ignorance. I can do nothing to erase the loss his death brings to his family and friends. All I can do is try to do what is right, as he seems to have done, and hope that others learn to do likewise in increasing numbers.

This project continues.

Planning October Shipment

2006-09-28T02:50:00.000-07:00

The next shipment to the hospital will be in early/mid October and preparations are well under way. The hospital has said how the budgeted funds should be spent, funds are in place at LIFE, and a preliminary heads-up has gone to the helpers at Mosul Airport. Now I begin to watch and worry and nag and make sure the plan happens as best I can.

It continues to be easier to send and make sure they get there than to find people willing to pitch in and help expand the project. The shipments are getting there almost like clockwork. My efforts to attract support from others (individuals, NGO's, anybody who will listen) continue to be far less successful. It's hugely frustrating and could break a persons will to be totally ignored or politely told "no" or passed off to someone who doesn't care time after time after time. I lost it while talking to a receptionist at one NGO last week - when she offered to put me through to someone's voicemail I said "I think I'll go beat my head against a brick wall instead, it will be more productive". Obviously not a responsible businesslike way to act, and I need to do better.

Another shipment reaches the hospital

2006-09-18T18:13:00.000-07:00

I got confirmation from the hospital that the latest shipment reached them Monday September 18th. This shipment was identical to the last:

- 34 Doxorubicin 50 mg vial
- 45 Vincristine 2 mg vial

The icepacks in this shipment were found melted when the shipment arrived at the airbase although they were reportedly still cool (~60F estimated). The shipment traveled in two boxes instead of one larger box like previous shipments and it is suspected that this was the reason the icepacks were depleted. Efforts are underway to ensure that future shipments are packed better (bigger box, more insulation).

I'm working now on organizing the next shipment. First I will find out if anybody else has sent donations to LIFE recently and add what I usually do to the total, then let the hospital know what money is available and ask them what should be sent, then let the pharmacy know, make sure LIFE sends the money to the pharmacy, make sure everybody on both ends knows the shipping schedule and is ready, and finally watch another shipment make it's way to Mosul. Oh yes, also gotta help the pharmacy find a reliable source of big, insulated shipping boxes.

I'm also working on trying to get more folks to help: sent emails to a couple of NGO's in the last week or so and am approaching a local church which has shown some interest. I desperately need to find others to help if there is to be any hope of overcoming the terrible shortages at the hospital - it's hard for me to beg for money from others, and hugely frustrating hitting a stone wall when I approach NGO's and such, but it needs to be done. The total tab for the latest shipment was $3864.25 ($3485.25 for drugs, $379.00 for FedEx shipping). $400 of this was covered by donations from others, the rest by my own.

Interview on Chicago Public Radio

2006-09-07T15:13:00.000-07:00

An interview about this project aired today (September 7, 2006) on Chicago Public Radio as a segment of their "Global Activism" series. I got a call from a nice guy in Chicago who heard it, and I found a link to it (and other recent segments in the series) on the station's website here: Link to Interview .

The interview was actually recorded several weeks ago and I was never sure exactly when or if it would air so it was a bit of a surprise to get a call about it today, a very welcome surprise. It is the first media coverage of this project I am aware of, and should bring word of the project to many people who may wish to help.

Folks who are interested in the project are welcome to contact me - I'll try to answer any questions they may have about it. My email is ph_kosel@cwo.com . My other contact info is in the blog description at the top of the page just below the title.

Folks who are interested in helping with this project can do so either by

(1) helping to call it to the attention of as many people as possible; or by

(2) donating funds to help pay for drugs and shipping costs. Please see my previous post Introducing LIFE for specific info on how to donate to the special earmarked "Mosul Hospital Fund" which Life for Relief and Development has established. Donations via LIFE will be tax deductible and all funds are being applied within a month to pay for shipments with the sole exception of a 10% reserve being held to cover LIFE's book keeping and overhead costs .

September shipment scheduled

2006-08-27T03:30:00.000-07:00

Another shipment has now been scheduled and funded for September. It will leave Minnesota the Monday after Labor Day. The best day to ship has proven to be on Mondays because it seems to fit into a "sweet spot" in the flight schedules and get the drugs to Mosul in the least possible time.

Why Kimadia is Failing to Supply Drugs in Mosul

2006-08-21T13:36:00.000-07:00

I was cruising the web looking for help for this project and I came across this World Health Organization report on the drug supply situation in Iraq.

link to report

It's a big and rather bureaucatic and hard to read document, but it provides at least some perspective on the nature and source of the problems that are causing Kimadia and the MOH to fail the patients of Mosul so miserably. Based on the report, Mosul's problems are not unique.

5th Shipment of 2006 reaches hospital

2006-08-14T13:08:00.000-07:00

I got the email confirmation that the shipment reached the hospital safely.

Subject: 5th Chemotherapy Shipment received
Dear Mr. Kosel
Salaam and Greetings from Mosul

Today, August 14, 2006 at 12.15 p.m. the ISCP & the hospital received the 5th chemotherapy shipment of 2006:

- 34 Doxorubicin 50 mg vial
- 45 Vincristine 2 mg vial

Now Mr. Hirano and the D.G of Health in Mosul were very helpful in arranging transport and delivery.

I already received the invoice for our records.
I shall send you photos of this shipment and the 4thshipment received in July 2006 later on.

Thank you for your help to our cancer patients.

Worrying shipments to their destination

2006-08-13T23:54:00.000-07:00

As I write this, another shipment is being handed over to an ambulance sent by the hospital to Mosul Airport if things have gone as planned. It's almost midnight here in Califrnia and almost 11AM Monday in Mosul. I'll know in a few hours if everything went well, but it has gone smoothly in the past and I assume things will be no different this time. Still I worry, because I am half a world away and all I can do is wait and worry. Every time a shipment gets to the hospital I feel like I worried it every inch of the way on it's journey, checking FedEx tracking data and sending emails and making phone calls to try to be sure everything will go smoothly.

The last couple of weeks have been hectic because one of the helpers at the airport transferred out and a new helper transferred in and was handed responsibility for the all important refrigerator where the drugs stay until they can be picked up by the hospital. Like his predecessors he was more than happy to lend a hand but it's always a bit of a shock to people's sense of place to arrive in Mosul judging from the emails I get - little is said, but the sense I get is that it takes a while do get things down to a routine and get one's feet under one.

The new helper's name is Ken. He's done yeoman service so far, helping get two huge and totally unexpected pallets of ostomy supplies shipped by Friends of Ostomates Worldwide (FOW, http://www.fowusa.org/ ) passed off to two ambulances sent from the hospital . I knew FOW was sending the shipment, but had been told it would be carried all the way to the hospital with no need for help at the airport. Unfortunately the shipping agent misunderstood the situation in Mosul and shipped via Mosul Airport, where all freight needs military clearance before it can be moved off base. I got a phone call in the middle of the night from my contact at the hospital reporting that a storekeeper had gotten a garbled email address over the phone and they needed help locating and collecting the supplies. The email address turned out to be for the DHL office at the airport and within few days Ken and the DHL folks were able to set up an appointment and meet the ambulances at the airport gate with the pallets on a forklift, where the thirtysix cartons of ostomy supplies on the pallets were loaded on the ambulances and whisked to the hospital.

Tonight (today in Mosul) Ken will be taking an insulated carton of chemotherapy drugs with fresh ice packs in it to the same gate and meeting another ambulance. I am sure everything will go smoothly. Still, I worry, and will continue to do so until I get an email confirmation from the hospital of it's arrival. Perhaps worrying helps.

Fourth shipment this year reaches the hospital.

2006-07-19T02:09:00.000-07:00

I got confirmation from the hospital that the latest shipment, the fourth so far this year, reached them safely on Monday July 17th. This latest shipment contained 30 50-mg vials of doxorubicin and 40 2mg vials of vincristine.

The hospital also got a shipment this month of drugs from Kimadia (the government agency responsible for supplying them with drugs) that included 540 10-mg vials of doxorubicin. The hospital's calculated annual need for doxorubicin, what they requested from Kimadia at the start of the year, is 4000 50-mg vials and 3000 10-mg vials. The entire supply received from Kimadia, all 540 vials, has already been dispensed to patients. The meager amount in the shipment I sent will no doubt be also exhausted before my next shipment reaches them.

Doxorubicin is only one of many drugs in desperately short supply at the hospital. The hospital's calculated annual need for vincristine is 7500 1-mg vials and 250 5-mg vials. None has yet been furnished by Kimadia this year. The meager amount I managed to send will no doubt be exhausted before a month is out.

I remain resolved to do what I can. I remain frustrated that I am so unsuccessful in attracting others to assist this project.

Photos

2006-07-08T11:55:00.000-07:00

I have various photos the hospital has sent me that provide ample evidence that the shipments are getting where they are intended to go and reaching patients. Security considerations require that I not pass on anything that could place the folks in Iraq at risk, but I need to reassure anybody that wants to help that this is a real project doing real good and helping real people.

This is a photo of a courageous young girl getting treatment using some of the drugs that were sent. I can only hope that the treatment helped. The fight against cancer is never won 100%, chemotherapy is only a way to improve the odds and try to extend the span of years. If this one patient lives a full life it will be worth more than anything you or I could ever spend on this project.

This is the refrigerator at the hospital with the drugs from one shipment stacked on the shelves. These drugs are the same as those used in US hospitals and have been kept under the necessary refrigeration every inch of their journey to Mosul. Each little carton contains a little vial of liquid, more or less the amount needed for one treatment for one patient depending on dosage and things I have never been trained to judge. The doctors tell me what to send, the doctors treat the patients, I'm just a helper.

Before a month elapses and I can send another shipment, this refrigerator will be empty. The hospital treats about 2000 new patients a year. Thats 167 patients in an average month, and each patient getting chemotherapy usually needs several treatments.

I am plowing everything I can spare and more into this project. My credit card balance is bigger every month.

This project is very real, and it is very expensive, and what I can do on my own is simply not enough. I need to enlist others to help, and I am failing at that task. So far the money from other donors in the last two months totals $400. In the same period I've plowed $8250 into the project. I don't begrudge a nickle of what I've spent, and I don't blame those few others who have contributed for not contributing more because I know they have done what they can. I am only frustrated that I can not spend more myself and that I have not found enough others to help.

If anybody reads this, there are two ways you can help:

1. Tell other people about this project, as many as you can, as loudly as you can, as often as you can. Tell your friends, tell your local radio and tv stations, tell doctors, send emails, write letters to the editor, spend some time on it, don't be ashamed to make a pest out of yourself and don't quit just because people tell you "no". Tell people to come to this website http://waldschrat.blogspot.com/ and read this project blog and do what they can to help. A burden that is too heavy for one is light work for many. I need to recruit LOTS of people to help on this project. Spread the word, HEROS WANTED!

2. Give what you can. Call the folks at LIFE and make a donation over the phone with your credit card, or send them a check, being sure to tell them that the donation is for the "Mosul Hospital Account". You'll find contact info for LIFE here.

Plan, ship, plan, ship ... it becomes a routine

2006-06-25T10:47:00.000-07:00

I'm essentially acting as a communications liaison and funding source for the hospital in organizing these shipments. No other major sources of funding have materialized so far although a few of myfriends and correspondents have chipped in from time to time. Also, the folks in Mosul report they identified a local source for Natulan (cyclophosphamide) this month and found a source for funding so they asked me to send increased quantities of Vincristine and Adriamycin (doxorubicin).

Every month the routine is the same. Contact the hospital and see what they want within the limits of the available funds, verify the prices and shipping costs with Ameristat, transfer the funds to Ameristat for the shipment, track the shipment, verify that the drugs reached the hospital, and start over. So far it has worked 5 times (twice last year, three shipments this year) and the sixth shipment is in the works and will probably reach the hospital in mid-July.

Of course there is the problem of paying for it all. I've been fortunate this year. Last year I spent a lot of money and effort repairing three rental houses I own. This year I have tenants in all three houses, so I'm able to apply that rental income to the shipments. Additionally I'm pulling in social security this year. Theoretically it should be enough to cover the shipments, but my credit card balance has been swelling ominously and it seems every unforseeable expense and it's brother is descending on me to try to disrupt the project. The air conditioner on my house went out and had to be replaced, my step daughter needed a new car after hers was impounded for implausible but highly entertaining reasons, some idiot destroyed my pickup truck parked at the curb in the middle of the night by ramming it with his own vehicle, the tenant at one rental house is out of work and the rent is delayed, etc, etc, etc.

I remain intent on sending shipments each month, but I am not sure how long I can maintain this series of shipments given the series of unpredictable and unavoidable expenses that seem to piling up on me.

Ultimately, even if I can maintain the current shipment series on a monthly basis it will not fill the hospital's needs and the hospital's patients will continue to suffer.

Others can help by sending donations to LIFE as described in my previous post ( http://waldschrat.blogspot.com/2006/06/introducing-life.html ). Alternatively, they can help by directing others to this blog and spreading word of this project.

Another shipment arrives at the hospital.

2006-06-13T13:12:00.000-07:00

The hospital's internet service is out again (no email) but I was able to confirm by telephone that another shipment reached the hospital June 12th, 2006. Deliveries of chemotherapy drugs by Kimadia, the hospital's normal source of supply, remain essentially zero this year, much worse than last year. All the drugs in the shipments I am sending are used up before the next shipment arrives, and the hospital has no reserve inventory at all. Yet what I am able to send is only a small fraction of what is needed.

The contents of the current shipment were the same as the last:
20 50-mg vials Adriamycin (also called Doxorubicin)
25 2-mg vials Vincristine
30 1000mg vials Cyclophosphamide (also called Endoxan)

This packing list is in no way random or arbitrary, it is what the doctors at the hospital report is the best use of the of the available funds, what will save the most lives. I rely on their judgenent and ship what they ask for based on the money available each month.

Correction: I went back and checked, and this shipment was actually somewhat different from the previous one, which included 10 more vials of doxorubicin than this shipment.

Introducing LIFE

2006-06-04T11:26:00.000-07:00

UPDATED AUGUST 2007 - SEE ANNOTATIONS IN RED

AT THIS TIME I CAN NOT RECOMMEND DONATING TO LIFE TO SUPPORT THIS PROJECT UNLESS
(1) THE CONTINUING EXISTENCE OF LIFE'S "MOSUL HOSPITAL FUND" IS CONFIRMED BY THE PERSON ACCEPTING THE DONATION, AND
(2) ASSURANCES ARE GIVEN THAT THE DONATION WILL BE USED TO SEND CHEMOTHERAPY DRUGS TO THE MOSUL ONCOLOGY AND NUCLEAR MEDICINE HOSPITAL.

I wrote in a recent post about developing a cooperative relationship with an established charity so donations made to support the Mosul hospital would be properly tax deductible. I would now like to introduce that organization: Life for Relief and Development, or “LIFE” for short ( on the web at http://www.lifeusa.org/ ).

I first became aware of LIFE when trying to solicit donations of chemotherapy drugs directly from pharmaceutical manufacturers. I found that manufacturers were unwilling to make charitable donations except to official, properly recognized charities (which I was not), but that more than one manufacturer reported making donations to a charity called Americares ( on the web at http://www.americares.org/ ). Contacting Americares, I learned that their support to Iraq is channeled through LIFE and I was referred to their contact at LIFE. I learned that LIFE has managed numerous shipments to Iraq although their usual shipping methods were not well suited to transporting chemotherapy drugs that need refrigeration. I consider the confidence placed in Americares by multiple pharmaceutical manufacturers a strong confirmation of Americares’ legitimacy and trustworthiness: Americares is a totally legitimate organization. I consider Americares’ choice of LIFE as a partner to be a strong vote of confidence in LIFE.

Needing a way to channel donations to the hospital though a reputable and officially recognized charity I approached LIFE and they agreed to set up an earmarked account for this purpose. To verify the workability of this arrangement I tested it by sending the funds for my most recent shipment to LIFE and letting them in turn deliver payment for the shipment to Ameristat (the wholesale pharmacy that actually ships the drugs). Although we encountered a few glitches they were quickly resolved and it worked. The drugs will be sent in two parts, one package shipping from Germany this coming Tuesday and one package shipping from Minnesota on Monday. LIFE will be kept informed of the shipment’s progress via FedEx tracking numbers, email confirmations by helpers along the way, and photographic evidence of arrival at the hospital’s front door and proper storage in the hospital’s refrigerator.

If anyone would like to help by donating to this project to support future shipments, here is how to do it.

First, be aware that you must carefully tell LIFE that your donation is for the "Mosul Hospital Account" if you want it to be applied to sending supplies to the hospital. Mark this on your check and/or in a cover letter if you mail a check, and mention it carefully to the person on the phone if you make a donation via credit card over the phone. Although LIFE has an automated web payment system for donations it is not yet possible to route donations to this specific account over the web, so make donations intended for the hospital only by mail or by phone. If you do not carefully indicate that your donation is intended for the "Mosul Hospital Account" your donation will not be earmarked for the hospital!

You can
Either
(1) Call 1-800-827-3543 and ask for:
OBSOLETE CONTACT INFO
Mr. Jehad Al Qalyubi (Ext 7223) (NO LONGER WITH ORGANIZATION)

or
OBSOLETE CONTACT INFO
Ms. Besan Noor (Ext 7222) (IMPOSSIBLE TO CONTACT IN MOST RECENT ATTEMPT)

( I have verified that these two folks know of this new account and they can take your credit card information over the phone. Be sure to explain that the donation is for the Mosul Hospital Account. ) SEE NOTATIONS IN RED ABOVE AND BELOW

At this point I am not sure how or if donations can be made through LIFE to support this project. My previous contacts there seem to have moved on to other jobs elsewhere, and I have not developed new contacts yet. To the best of my knowledge, all donations of which I am aware to LIFE's "Mosul Hospital Fund" by myself or others were properly accounted for and applied 100% to drugs and necessary FedEx shipping costs, including the 10% reserve originally intended to cover LIFE's overhead expenses related to this fund.

Or
(2) Send your donation by mail to:
LIFE For Relief and Development
17300 W. 10 Mile Rd
Southfield, MI 48075
( Again, be sure to indicate that the donation is for the Mosul Hospital Account )

On becoming a salesman...

2006-06-02T02:26:00.000-07:00

I am not a salesman, I am not a people person, I am an engineer. My idea of persuading somebody of something is to do the math and hand them a written report, not to schmooze or cozy up to them and try to be their buddy. Yet I am faced with the need to recruit others to help the hospital get what it needs to save lives. I need to pitch the project, I need to explain the need, define the benefits of committing the money, make people understand the importance of helping.

To me the math is pretty simple. Take a hospital that gets one or two thousand new cancer patients a year. Subtract from that hospital the drugs that it needs to treat those patients. What you get is dead patients.

In Mosul and the surrounding territory, the government-run Mosul Oncology and Nuclear Medicine Hopital is the primary source of treatment for cancer patients. The supply system it depends on for drugs is not working well at all - requisitions are not filled or only partially filled, deliveries are unpredictable and erratic, and the drugs that are recieved are sometimes near the expiration of their labeled shelf life.

I've proved that it IS possible to deliver chemotherapy drugs to the hospital by doing it. It's not easy, it's not cheap, and the logistics is complicated, but it CAN be done, it IS being done. The sticking point is money. The quantities I can personally afford to send are NOT sufficient to meet the needs of the hospital and it's patients.

Currently I'm plowing all my excess income into this project. This is about enough to send one shipment a month of the most needed drugs. If I can persuade others to help fund this project, then additional shipments can be sent each month (perhaps one a week) and larger shipments could be sent.

I'm working on arrangements to channel funds through an established charity and in fact the funds for my current shipment-in-progress were channeled through that charity (I sent em the money and they paid for the shipment). The advantage of doing this is the donation will be tax deductible. I haven't worried too much so far about tax deductions, but I've discovered that others do sometimes.

More later - it's past 3AM here and I'm getting too sleepy to write coherently.

Blog mechanics

2006-05-31T16:48:00.000-07:00

I have been puttering off and on with the "template" for this blog, identifying methods that can be used to better present information about chemotherapy drugs and the needs of the hospital. I was able to add to the sidebar a few comments regarding the blog and some links related to chemoterapy drugs. It's not what I consider great progress but it's an imrovement.

Another shipment arrives successfully

2006-05-09T01:08:00.000-07:00

I got word from the hospital Monday May 8 that another shipment reached them successfuly. The shipment went in two parts, one sent from Germany and one from Minnesota. Both arrived at the airport on the same flight. The Minnesota package left as scheduled on Monday May 1 the one from Germany a few hours later, technically May 2 in Germany. Both were safely fridged up over the weekend by helpers at the airport before the transfer to the hospital.

The following was in this shipment:
35 50-mg vials doxorubicin
20 2-mg vials vincristine
10 1-g vials cyclophosphamide

I find myself both glad that these drugs will help the patients in Mosul and saddened by the knowledge that ongoing shortages will imperil the lives of many patients. I am doing what I can to help, but my resources are limited and, in comparison to the hospital's annual needs, woefully inadequate.

Whoever who reads this, I hope they will consider helping. I can be contacted as indicated at the top of this web page, and there is an email link in my profile that will reach me.

Correction: I went back and checked the invoices and email traffic and found that 30 vials of cyclophosphamide, not 10, actually was shipped and received.

Planning future shipments

2006-04-20T02:28:00.001-07:00

At this point I am hoping to be able to send a series of monthly shipments. The next one should be sent May first, 2006.

From what I can tell the hospital's supply situation is pretty dire. The hospital requested 89 different drugs from Kimadia for the year, indicating the estimated amount needed for the year. Only partial fills on about 7 of the requested drugs have been delivered by Kimadia as of April 15th, over a quarter of the way into the year. That means the vast majority of the drugs needed to treat patients' cancer are not available at the hospital.

I have tried to take a positive view on Kimadia's performance. Surely, they delivered SOME of what was ordered in 2005, and they have delivered SOME of what is needed this year. For what they have delivered they deserve praise, because these are difficult times in Iraq and even simple utilities like water and electricity are not being delivered reliably by the agencies responsible for doing so.

However, while praise is due Kimadia for the few supplies it has delivered, people in Mosul are suffering from severe, near-total shortages at the hospital of chemotherapy drugs needed to fight cancer. The hospital is the primary lifeline for these people, particularly the poor. Patients who are wealthy may be able to seek treatment elsewhere or obtain the needed drugs through private pharmacies, but otherwise folks depend totally on the system that should be providing health care to all Iraqis. That system is suffering from severe shortages. Kimadia is the agency that should be delivering the drugs. Whatever the reasons, it is not doing that job well at this time.

Lest people think I blame only Kimadia for the problem, let me be clear.

The health system of Iraq was supposedly one of the first things considered when the US invaded Iraq. The supply problems of the health system have been well publicized. Various agencies and organizations have claimed credit for helping that health system. Yet, shortages persist and are even worsening in the current time period.

Another shipment complete

2006-04-11T04:25:00.000-07:00

I got word from the hospital in Mosul that the latest shipment of chemotherapy drugs reached them today. The drugs reached Mosul airport OK late last week, with the icepacks still cold, and were held there in a refrigerator until they could be picked up this week.

This shipment included 50 2mg vials of vincristine and 17 100mg vials of doxorubicin shipped from Minnesota and 50 200mg vials of cyclophosphamide shipped from Germany. Roughly 100 email messages were involved in arranging and coordinating the shipment, and people around the world watched out for it, passed it from hand to hand, carried it a little faster and protected it a little better than other packages, knowing it might save some lives in a place that's seen too much violence and chaos in recent years.

The message from the hospital says "This shipment of chemotherapy drugs will be of tremendous help to our cancer patients at this time of great shortages."

What works, what doesn't.

2006-03-24T01:14:00.000-08:00

It's March, 2006 now. I spent quite a bit of effort in recent months trying to contact drug manufacturers and get them to donate supplies for Mosul.

I found that drug manufacturers do make charitable donations of drugs BUT they are largely oriented toward donating only to officially recognized tax-exempt charities.

Interestingly, the US tax laws preclude individuals like myself from being recognized as a tax-exempt charity, and also preclude foreign organizations like the hospital or any organization in Mosul. The reason for this is not 100% explicit in the tax laws, but I think it has to with accounting intricacies rather than xenophobia - the exclusion is not applicable to Mexico and Canada because they apparently have some sort of tax treaties with the US.

I contacted a couple of charities that claim to serve the middle east and Iraq. One has subsequently been accused by the FBI of aiding terrorists. Another reported that they generally ship stuff only in huge cargo containers, a practice which would be extremely detrimental to chemotherapy drugs that need refrigeration.

Anyway, I have a new shipment of chemotherapy drugs in progress, the order was placed today and I hope for delivery in early April. I have not told my wife yet, I hope she will understand that the expense is something I believe we can afford and the cause is worthy.

If anybody has ideas for a charity or organization that might be able to channel funds toward this ongoing project I hope they will let me know. My resources are simply not sufficient to fill the hospitals overall needs, what I am able to send is only a drop in the bucket compared to what they need.

I do not find it encouraging that Kimadia's website and that of the Iraqi Ministry of Health have vanished from the web. The hospital is also apparently without email service at this time.

Shipping Methods - Getting it to Mosul

2005-10-12T11:00:00.000-07:00

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.

Ameristat's website

2005-10-10T02:54:00.000-07:00

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

2005-10-10T01:24:00.000-07:00

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.

2005-10-09T02:11:00.000-07:00

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

Chemotherapy drugs for Mosul

2005-10-09T01:56:00.000-07:00

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.

A reflection

2005-03-11T07:01:00.000-08:00

My real blog, which I only maintain occaisionally, is at

http://www.livejournal.com/users/waldschrat/