Inside the largest hub for global humanitarian medical aid in the US

SANTA BARBARA, Calif. — The boxes of supplies at Direct Relief, a nonprofit medical relief organization based in Santa Barbara, California, tell the story of the disasters happening around the world. Shipments are stored on pallets with labels noting their destinations: Libya, Bangladesh, Syria. Other boxes headed into more sensitive contexts are unmarked to avoid jeopardizing the safety of the organization and its partners. “We wanted to make sure there were not lesser standards for people who happen to be low-income.” --— Thomas Tighe, CEO, Direct Relief Since its founding in 1948, the nonprofit has provided medical aid in response to emergencies and in support of refugee populations. Direct Relief completed its new 155,000-square-foot headquarters in 2018 in order to meet heightened federal requirements for the storage and shipment of prescription medications and the increased demand for humanitarian assistance globally. “The dedication of the building is really a rededication to the cause,” Thomas Tighe, the organization’s CEO, said earlier this year. “What it represents is a much greater capability to help more people — with tools that we have embedded in it, with the experience of 70 years, to bring those together in this building so we can do more in the same efficient way we’ve always tried to do it.” In February, the magazine Fast Company featured the organization as one of the top three most innovative nonprofits for “reshaping how people respond to disasters.” The return on investment in this new headquarters depends on whether Direct Relief can do its work at greater scale. Meeting high standards Tighe pointed to a glass case of certificates the nonprofit has received to operate from across all 50 states, just past the doors to the entrance of the new headquarters: “We are meeting the highest commercial standards in the heaviest regulated country,” he said. Of the 644 pharmaceutical certified warehouses across the United States, only two are humanitarian nonprofits, but Direct Relief meets the same standards as the commercial warehouses, Tighe explained. There is no global regulatory agency for drug distribution. But in the U.S., Direct Relief must work within regulatory frameworks at the state and national level. The nonprofit brings those same high standards for storage, safety, and security to its international medical response. “We wanted to make sure there was a charitable channel as good as any commercial distribution channel,” Tighe said. “We wanted to make sure there were not lesser standards for people who happen to be low-income.” In 2016, the organization announced a $40 million fundraising campaign to build this humanitarian distribution center. Direct Relief was outgrowing its old headquarters as it saw increased demand from emergencies around the world and needed more room to store and ship supplies. Unlike many nonprofits, the organization does not receive any government funding, so it relied on contributions from individuals, foundations, and businesses to fund the largest project in the organization’s 70-year history. Strengthening health systems Direct Relief responds to everything from the mudslides in Santa Barbara, to fires spreading across the state, to natural disasters across the country and around the world. One of the major areas of focus for the organization is access to medicines in an emergency. For people who usually manage their disease with medication, their condition can worsen when a disaster hits, staff explained to Devex on a recent visit to the headquarters. Emergency rooms are often filled with people with conditions such as diabetes following disasters. Increasingly, the organization is setting itself up not just to donate emergency medical supplies, but also to build local capacity, both in places with protracted humanitarian crises and other areas with inadequate access to decent health care. For example, for two years, Direct Relief has worked with the Pan American Health Organization to train national emergency medical teams so countries affected by disaster are less reliant on international emergency medical response. When in-country responders receive medical supplies, the question is not how to use them, but “how to manage those supplies, how to store them, how to distribute,” said Dr. Ciro Ugarte, director of health emergencies for PAHO at the World Health Organization. Direct Relief has been an ideal partner in PAHO’s work to build the capacity of emergency medical teams because of their expertise in operations and logistics, which is unparalleled among NGOs, he said. Stockpiling supplies Inside the storage area at Direct Relief, flags from around the world hang from the high ceilings, and rows of metal racks stacked with supplies stretch from wall to wall, as transport vehicles make their way down the aisles. Wearing jeans and a neon orange vest, Tighe walked toward the refrigerator at the facility, a 7,000 percent increase to its former cold chain capacity, as beeping vehicles rolled by to load boxes for delivery. The larger facility makes it easier to store and ship more emergency medical supplies, he said. Direct Relief stockpiles supplies so they can be ready to ship out at a moment’s notice, whether it’s gas masks for the California fires or suits to protect health workers responding to Ebola. That is in contrast to VIA Global Health, for example, a for-profit model that sources, purchases, and ships medical devices and supplies. “Having warehouses, you’re far more capital intensive,” said Noah Perin, co-founder and CEO of VIA. Warehouses make sense in cases of acute need versus consistent demand, he said, explaining that Direct Relief is in a better position to respond quickly with emergency supplies than for-profit models without similar storage capacity will ever be. But when the need for health supplies is consistent, for-profits are better suited to ask what the market wants and find the best products and negotiate rates based on that, he said. Partnering with the private sector In the digital era, when most of the information that is valuable to humanitarian organizations is in the hands of private companies, public-private partnerships with a range of companies become more critical than ever, Andrew Schroeder, director of research and analysis at Direct Relief, told Devex. “There’s no such thing as a distribution company that’s not first an information company.” --— Andrew Schroeder, director of research and analysis, Direct Relief Multinational delivery service FedEx, for example, provides Direct Relief with credits, essentially shipping medical supplies at no cost, across the country and around the world. “Our collaboration runs much deeper than simply writing a check,” said Jenny Robertson, vice president of corporate communications at FedEx. The partnership helps each side harness the other’s skills, she said. Direct Relief not only partners with the private sector but makes introductions between the companies it works with and other organizations that might benefit. Hope Foundation for Bangladesh, which provides health care to underserved women and children in rural parts of the country — including refugees from Myanmar — has worked with Direct Relief since Cyclone Sidr in 2007. Direct Relief has connected the organization with partners including Unilever, according to Iftikher Mahmood, the founder of Hope Foundation. Unilever owns Vaseline, a brand that had a number of skincare products visible throughout the Direct Relief warehouse, ready for shipment to people living in crisis and disaster whose skin conditions might otherwise go untreated. Unilever supported a skin healing camp in Bangladesh in November 2018, where 13 dermatologists saw 2,000 patients in three days. Mahmood said support from Direct Relief, both directly and through its partners, saves him hundreds of thousands of dollars on drugs and has allowed him to bring new services to the people he serves, including telemedicine. Direct Relief’s Schroeder sat in front of two large computer monitors. He had GeoInsights, a program that uses Facebook data to track population flows, open on his screen, as well as a Slack account where he interacted with others who use the Facebook data for disaster response. “There’s no such thing as a distribution company that’s not first an information company,” he told Devex. Schroeder and his team are constantly tracking the flow of information, including what orders were placed, who placed them, and why they were placed. Increasingly, they are turning to big data sources like social media to apply machine learning to their work. That way, Schroeder and the team can figure out what people might need before they need it.