Five years ago today, a massive earthquake rocked the island nation of Haiti. Within hours, Partners in Health, the largest provider of health care in the country and the organization for which I work, was delivering care in Port-au-Prince. The outpouring of support overwhelmed us. By some estimates, half of all American households contributed to the relief effort.
And they didn't just write checks. When one sees images of homes and lives in ruin, the impulse is to do more than give money, to give something to ease the suffering of others. After the earthquake, individuals donated clothing, toys and household items. Similarly, we received significant corporate donations of medicines and medical equipment for dealing with trauma. These in-kind donations, as they're known, filled a critical gap in the response efforts, both by supplying us with necessary items and by allowing us to use our funds for other priorities.
While most of the materials offered in the aftermath of the earthquake were valuable, we also received many unsolicited and inappropriate donations, both from corporations and from individuals, including unwashed sheets, nearly expired medications and, famously, a single Rollerblade skate. When in-kind donations are not well-considered, they slow response efforts by diverting staff time to sorting or disposing of unwanted goods.
How can nonprofit and nongovernmental organizations work with potential donors, both individuals and corporations, to ensure that in-kind gifts have the greatest impact? And can we come up with a strategy to apply to the Ebola crisis, for which donations, both cash and in-kind, have lagged?
To make in-kind giving most effective, nonprofit organizations should give priority to the standards for in-kind gifts set by a country's ministry of health. And we must do more to communicate our needs to would-be contributors. One obvious solution is for an organization to post lists of needed materials on its website. While these lists need to be constantly monitored and updated, they present an opportunity for greater donor engagement. The best donor understands the complexities of in-kind giving and wants to ensure that his or her gift has the greatest possible impact.
It is also critical that organizations become comfortable saying "no" to a proposed donation. In the days and weeks after the earthquake, PIH turned away almost as many in-kind donations as we accepted. Some were valuable, but given the post-disaster conditions in which we were operating, we knew we could not properly store, distribute and support such items as energy-intensive water filtration units and complex surgical equipment. Other donations were declined because they were wholly inappropriate. Unfortunately, many organizations feel compelled to accept everything a corporation or donor offers. The fear is that if they refuse one donation — even for rational reasons — the donor won't be inclined to step up in the future.
On the other side of the equation, donors must come to understand that not all gifts are welcome. Materials that may be valuable in American hospitals and emergency centers can't always be easily transferred to a rural clinic or emergency field hospital. Even seemingly simple donations of clothing can have long-term, unintended effects. For decades, Haiti has received containers of donated clothing and shoes (often called "Kennedys", as the shipments began under the Kennedy administration). This steady stream of T-shirts and jeans and sneakers has fed a robust resale market, effectively putting many local tailors and cobblers out of work.
It is critical that these on-the-ground realities — combined with the experience of local staff — guide the decision to accept donated materials. For example, when we were assessing donated X-ray machines in the wake of the earthquake, we ran through a checklist. Can the electrical system support the machine? Who will cover the ongoing costs of operating the X-ray? Older, film-based X-rays require chemicals to develop images. What are the environmental impacts of disposing of those chemicals? Are spare parts available and are there technicians who can service the machine?
What it comes down to is that the donor can't just drop stuff off and feel good about it. A donor, whether an individual or a corporation, must get to know the recipient. That's especially critical for corporations that make large in-kind donations. We need to move beyond the image of the bountiful donor and the supplicant organization begging for castoffs and move toward true partnerships, where each party brings something valuable to the table.
To that end, it might help to look at the growing trend of corporations creating social responsibility programs. The idea is that the corporation will consider the financial, social and environmental benefits — and, indeed, all of the implications — of its interventions.
Material donations can be tremendously helpful when disaster strikes, as they were in Haiti. And they could make a difference in West Africa once the acute Ebola crisis is past. The nations most affected will need significant support to build well-equipped facilities with highly trained staff. Done well, and done in partnership with individuals and corporations, in-kind gifts can transform health systems in dire need of support.
Recently a 4-year-old girl was brought to the University Hospital in Mirebalais, a facility PIH built in Haiti specifically to strengthen the public health system in the aftermath of a devastating disaster. This young child — who was not alive at the time of the 2010 earthquake — was diagnosed with tuberculosis using a donated X-ray machine and received immediate treatment. In her story we see how in-kind gifts can contribute to real and lasting change.
Kathryn G. Kempton is the director of international operations for Partners in Health.
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