Methocarbamol

EDITOR--3As deputy head and consultants of the health department of EUAM (European Union Administration of Mostar) in 1995-6 we were impressed by Saunders's article concerning drug donations.[1] In Bosnia these problems appeared for a variety of complex reasons that have been widely recognised.[2-4] The problem of private donations in former Yugoslavia was exacerbated by the country's proximity to the countries of the European Community. Though drugs arrived quickly and inexpensively, they arrived unchecked (table and BMJ's website, www.bmj.com). There may also have been a sense of impotence and guilt heightened by the fact that the war was too dose to home to be ignored.

During our time in Bosnia the mayor of Mostar wrote to the European presidency and to all international non-governmental and governmental organizations of the European Union in an effort to put an end to unchecked donations. At the same time the city's health department forwarded a list of requirements for drugs that was updated monthly. Through accurate needs assessment, close contact with donor agencies, and cooperation with customs authorities it was possible to assess the appropriateness and quality of medical deliveries arriving in the city.

Although strict guidelines are necessary,[5] as Saunders points out, they are not sufficient in the absence of effective coordination. It was our experience that (a) local authorities fear running out of medical supplies and as a result medical authorities are pressed for drug donations without regard to quality; (b) it is difficult to find adequate premises to store drugs; (c) qualified and motivated staff are lacking, a problem exacerbated by poor pay; (d) there is a lack of coordination between local medical authorities and non-governmental and governmental organisations; (e) once the drugs have been delivered to the medical institution it is very difficult to check how useful they have been--and this in turn renders the coordination of new donations more problematic; (J) reliable local political authorities are lacking.

It is essential in the immediate post-conflict situation that a capable and experienced working group be set up with well defined objectives in order to pinpoint urgent needs and see that these needs are met. Finally, serious consideration must be given to imposing sanctions against companies or institutions involved in dumping drugs.

List of some useless drugs donated to Mostar during the war

Gian Luca Quaglio former deputy head, health and social services department, EUAM Post-Graduate Medical School of Internal Medicine, University of Verona, 37134 Verona, Italy Paolo Mezzelani former scientific adviser of project Department of Community Medicine and Psychosomatic Medicine, University of Verona mezzelani@cmib.univr.it Claudi Cuchillo Consultant of Pharmaciens sans Frontieres, France Department of Biochemistry, Universitat Aut noma de Barcelona, Spain

[1] Saunders P. Donations of useless medicines to Kosovo contributes to chaos. BMJ 1999;319:11. (2 July.)

[2] Hogerzeil HV, Couper MR, Gray R. Guidelines for drug donations. BMJ 1997;314:737-40.

[3] Berckmans P, Dawans V, Schmets G, Vandenbergh D, Autier P. Inappropriate drug-donation practices in Bosnia and Herzegovina, 1992 to 1996. N Engl J Med 1997;337:1842-5.

[4] Autier P, Berckmans P, Schmets G. Inappropriate drug-donation practices in Bosnia and Herzegovina. N Engl J Med 1998;338:1473-4.

[5] World Health Organisation. Guidelines for drug donations. Geneva: WHO, 1996. (WHO/DAP/96.2.)3

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