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“Junk for Jesus” – The Commodified Gift: Donation in a Global Economy
By
Nancy Ann Hiett Gibson
Marylhurst University
Presentation for GLS Symposium
USC Campus – June 23, 2012
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“Junk for Jesus” – The Commodified Gift: Donation in a Global Economy
My presentation today will begin with providing you a brief background and description
of the project’s origins that will provide you with an understanding of the research problem.
This will be followed by the research question and then a discussion of the contributing factors to
the problem. I will then present my proposed new methodology and conclude with
recommendations. {CHG Slide}
In December of 2006, I was in San Benito, Petén, Guatemala visiting my friend Foster
Ortiz who is the hospital administrator for a charity missionary run hospital. At that time, they
had just received their license from the Guatemalan government for their newly opened 20-bed
hospital. It was here that I was first introduced to the phenomenon of “Junk for Jesus,” the act of
giving a donated gift that is of no use to the recipient. Hospital Shalom was reliant on donated
medical equipment and supplies from NGOs in order to be able to provide medical services. The
problem was that much of the equipment was broken, obsolete, missing parts, inappropriate,
and/or potential toxic waste. {CHG Slide} I began that day to document through photographs
and photographs provided by Foster the various items that had been donated to them but were
what Foster called “Junk for Jesus.” Another friend, who is the administrator for a community
project in El Remate, Petén, Guatemala that provides a free medical clinic for that village, who is
also reliant on donated medical equipment and supplies told me that, “We are tired of being the
last stop before the landfill.” {CHG Slide} By this, she meant, that much of what they received
was at the end of its life cycle with little or no usefulness left and they were the ones who then
had to pay to dispose of these donations in a landfill. In Guatemala, landfills are also the homes
of the families who earn their livings scavenging from what is dumped. In a study completed by
Duke University’s Biomedical program, researchers Perry and Malcom (2011) conducted a
limited field research project tracing donated medical equipment and assessing how much of it
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was in use; it was found that 40% of all medical equipment donations were not in use due to not
functioning. {CHG Slide}
This brings us to the research problem, over $220 billion are spent annually on medical
equipment; {CHG Slide} most of which has increasingly become state of the art high tech
computerized diagnostic and monitoring equipment. As such, this equipment is exactly the same
as end of life cycle consumer electronics equipment, it is electronic waste – known as e-waste.
E-waste is any item that contains a printed wire circuit board and plastic coated wiring. E-waste
is your smartphone, programmable coffee maker, laptop computer, iPad, and every piece of
medical equipment that contains a printed wire circuit board. {CHG Slide} E-waste disposal and
recycling is a global problem with an estimated minimum of 40 million tons of e-waste being
dumped annually and that number is increasing every year. Unfortunately, the recycling of ewaste is not a state of the art operation and much of it is done informally. E-waste contains the
following developmental neurotoxins: lead (Pb), mercury (Hg), cadmium (Cd), hexavalent
chromium [Cr(VI)], PBDEs (brominated flame retardants), polychlorinated biphenyls (PCBs),
dioxins/furans, and polycyclic aromatic hydrocarbons (PAHs) (Chen, Dietrich, Huo, & Ho,
2011, pp. 432-434). Researchers conducting studies in China at e-waste recycling and disposal
sites detected measurable concentration levels of the neurotoxins in the bark of trees, human hair,
breast milk and blood serum (Hong-Gang, Hui, Shu, & Zeng, 2010). The UNEP has authored a
study on the importance of e-waste recycling and notes that most e-waste that is sent to
developing countries is recycled through open air incineration (Schuelp et al., p. 62). This
releases into the atmosphere all of the neurotoxins to be absorbed by the local community and
their visitors. The research question for this thesis was how to stop the flow of end of life cycle
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donated used medical equipment from ending of in the landfills of the developing world to be
burned in the open air.
So what are the contributing factors for end of lifecycle medical equipment to be
donated? The first contributing factor is neoliberal political and economic policy that has
promoted privatization, free markets, and globalization. Neoliberalism promotes free-market
capitalism with little or no governmental regulation of business for ease of global business
transactions and private enterprise as the best method to deliver public good services. {CHG
Slide} The global value of the healthcare industry is in excess of $2.8 trillion dollars. The second
is an off-shoot of neoliberal policies and that is the growth of private non-governmental agencies
(NGOs) replacing the state to provide public good services to their citizens, to groups in need
and to developing countries. The third is the role of social psychology in developing advertising
and fundraising methods that exploit the psychological benefits of giving to the individual donor
through the creation of the objectified Other who is in need. {CHG Slide}
Neoliberal policies have promoted the privatization of healthcare to the private sector and
away from public health models. Neoliberal theory contends that privatization of services leads
to competition, which leads to better services for less money, and that should result in increased
access to services. I will briefly give one example where the implementation of neoliberalism
has had the opposite effect. Chile is one example where neoliberal economic reforms were
implemented approximately 30 years ago. Unger et al. (2008) note that prior to the
implementation of economic reforms, the Chilean healthcare system was successful and largely a
public health system. The public system utilized taxes collected from all wage earners to provide
a system of public hospitals. Alongside this the government created a new private insurance
system. The intention of the reformers was for the private system to become dominant, so that
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those persons with private insurance received care in relationship to their individual contribution
through the price of their policy, rather than through redistribution of services based on paying a
percentage of income to the government system (p. 542). Their research concluded that the
private insurance system favored the economic elite and in particular young males with little or
no health problems. Conversely women and the poor were excluded from purchasing private
health insurance based on their higher need for medical services. The research found that the
implementation of privatized health insurance did not reduce the amount of money spent on
healthcare, with expenditures being higher in the private system than in the public system. In
discussing the inequalities created by the private insurance market they note that 40% of private
health care expenditures benefited 16% of the population (p. 546). Thus rather than lowering
costs and increasing access neoliberal reforms had an opposite effect.
In developing countries, NGOs, who are private organizations, have increasingly taken
on the role of delivering public good services, such as healthcare. The act of removing the state
from providing services to its citizens and transferring this obligation to private organizations
depoliticizes these services. NGOs in the medical equipment field actively collect and distribute
used medical equipment. Journals and publications directed toward medical administrators,
materials managers, and nurses tout the benefits to their systems of donation. The donors believe
that even though their equipment has become old and obsolete and that it is no longer life saving
in their setting, it becomes life saving as soon as it is donated. NGOs use the monetary benefits
of donation to motivate health care professionals to donate equipment. NGOs also promote the
benefits of clearing out hospital storage areas of equipment that they will never use because it is
unreliable, obsolete, broken, or missing parts. Social psychologist who work to assist NGOs in
designing fundraising appeals have found that one of the most effective methods to elicit giving
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is by the creation of “the Other” as an identifiable victim. This transforms societal problems to
problems of “the Other” and allows for the idea that “giving something is better than nothing.”
My hospital administrator friend expressed his frustration to me that it was the NGOs
who decided what equipment was beneficial for him to receive. The NGOs are the ones who sort
and pack equipment, and then ship these items to the developing world. The recipient
organization has no say in what equipment that they receive. This is donation as a discourse of
power. NGOs, as organizations, are privately run, with mission statements and vision plans that
promote the goals, aspirations and world views of their board of directors and major donors.
NGOs operate in the realm of governmentality. What they give, who they give to, the condition
of items that give, all speak to the privatized nature of donation. NGOs are in effect regulating
what donations are distributed and to whom, they control the quality of the donations that they
deliver and to whom, and they restrict their recipients from being able to exchange or sell any
donations that are not useful to their patient populations. The relationship that NGOs have to the
corporations, hospitals and clinics that donate equipment to them is such that they are complicit
in the externalization of e-waste disposal costs to the recipient groups in developing countries.
Meanwhile, they report to be providing “health and hope to the world.”
This has led me to propose a methodology for receiving medical equipment donations
that would track the individual donation and its cost benefit value to the recipient organization,
that I call MED BCA. The recipients of donations need a way to assess the monetary values and
costs of each donated item that includes the environmental societal costs for its future disposal in
the landfills of the developing world. Resource economics and natural resource damage
assessment in a combined tool can provide recipient organizations and their governments a tool
to assess the costs and benefits to their patients, their communities, and to their eco-systems.
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Resource economics allows us to assess an item for its monetized value. Just the same as donors
are able to write off their self-assessed fair market value of a piece of medical equipment.
Recipients would be able to assess the monetized benefit value of the donation. Natural resource
damage assessment is the legal tool that allows for the litigation for recovery of damaged
monetized natural resources. Recipient organizations that are within a biosphere reserve or an
Unesco World Heritage site are example groups who can utilize this component. This involves
having a monetized value for the economic benefits of a natural resource; for example, the
economic value of eco-tourism or the value of an aquifer. This does involve monetizing or
setting a value onto specific natural resource. {CHG Slide}
To briefly explain how the MED BCA would work, I have created a simplified example.
We have the claimed monetized value of the piece of equipment. Next the piece of equipment is
assessed for its usefulness, in this example, the equipment has arrived non-functional and cannot
be repaired, so it is automatically given a value of zero dollars. Next all societal costs are
deducted from the zero value, these include transportation costs that have a separate line item for
the Co2 environmental costs. Next are the costs for disposal, which again include transportation
and the environmental costs of transportation. As you can see, this methodology demonstrates
that the costs of receiving this equipment are greater than its benefits.
The following are recommendations for further research. Resource economists need to
know the weight of the elements that are contained in different pieces of medical equipment. For
example, if an oxygen concentrator is donated they need to know by weight how much that piece
of equipment contains of elements that are toxic to humans and the environment. If the
equipment contains lead, the amount of lead needs to be known, and so forth. This will require
further research to obtain the amounts of toxic materials used in medical equipment. The next
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step would be to then partner with environmental scientists to determine the levels of each toxin
that are emitted through incineration. In addition, for each location where open air incineration
of equipment occurs, it is recommended that a partnership be developed between environmental
scientists, soil scientists, resource economists, biomedical engineers, and applied anthropologists
for a multi-disciplinary approach to the social and environmental impacts of end of life cycle
disposal of medical equipment that is e-waste that can be part of broader research conducted on
e-waste disposal and recycling issues in developing countries.
It is hoped that through the full development or even partial implementation of the MED
BCA that a dialogue will occur between recipients, their governments and NGOs to stop the flow
of broken and inappropriate medical equipment donations to the developing world.
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