Originally published in Sanlian Lifeweek(三联生活周刊) on Feb. 1st, 2020
The flow of donations from home and abroad to Wuhan is endless. However, the major hospitals are still dangerously running out of supplies. Red Cross Society systems in Hubei and Wuhan, which are the main organizations designated to receive donations, have become the targets of public criticism. They should have been well prepared for such a serious accident. But they have had a crisis of trust at the very beginning because of the lack of professional competence.
Our reporter visited the Wuhan International Expo Center (A) Warehouse of Wuhan Red Cross Society, which is located in Hanyang. In front of a huge pile of materials that covered an area of a football field, a few working staff were going through the procedures, with paperwork and reference letters in their hands. The modern logistics information system, which has been developed for years in China, was totally absent there.
On the one hand, the hospitals themselves are screaming out over the social media about the shortage of supplies, but there is no reliable statistics on the whole picture of the shortfall. On the other hand, nationwide donations are tremendously active yet also faced with countless obstacles.
Does a global health emergency have to be coordinated by the Red Cross Society? Isn't there a more efficient way to replace the Red Cross Society which is struggling with serious problems of low efficiency?
Journalists | Zhang, Congzhi (张从志); Wang, Shan (王珊)
Original Author | Zhang, Congzhi (张从志)
Translation | Chengji Translation Team
On the site of Wuhan Red Cross Warehouse (by Cai Xiaochuan)
The N95 mask on Li Kun's face had been there for three or four days when he had the interview with us on the morning of Jan 30th. He would sterilize that mask with boiling water or alcohol everyday after work, and put on the same mask the next day. He should have replaced it every 6 to 8 hours. But the hospital was really short of masks. They needed to save masks for the medical staff on the front line. Clinical staff had already started to use home-use shoe covers instead of medical shoe covers. We even saw a short nurse at the fever clinic of Wuhan No. 7 Hospital wrapping her shoes with the long pants of the protective suits.
"The goods are desperately in short supply. We hardly had any masks in stock in the past few days. There were only 50 left. We transported a batch of masks from Zhongnan Hospital of Wuhan University urgently, because we must make sure that masks are still available for medical staff on the forefront."
Li Kun is extremely worried. He is the vice director of the Medical Services Center of Zhongnan Hospital of Wuhan University. He was informed by the Hospital on Jan 22nd to lead the medical team to exclusively support Wuhan No. 7 Hospital, which is one of the first designated hospitals for the outbreak. The clinics there opened consecutively in two days, filling nearly 200 beds with patients.
The most worrying problem for No. 7 Hospital right now is the shortage of material supplies. A staff member told us that they had already adjusted the standards of material consumption many times in a few days. Originally, they could support the key departments, and then they could only provide 40 protective suits every day. Now they are even more strict, monitoring the usage of each specific person. Each doctor or nurse can only collect the materials once a day, and they must sign for that.
"Why is every hospital in such a shortage?" Since Jan 22nd, the alumni association of a university has already donated to three hospitals. Each of them told the association that their supplies could not ensure the running of the hospital. One of the staff members of this association told us that the donations were intended for their alumni in Hubei, aiming to solve their needs. Later they found that there is a terrible shortage in the hospitals, so they changed their minds and moved the materials there. "The first hospital that we got in touch with claimed they only had enough stock for 1 day's consumption. We sent some supplies to them after we verified their information. The latter two hospitals said they were merely 'Level 2' hospitals, and their protective devices had already bottomed out. Now we just solve the problems one at a time as they get to us, and that's it. Shouldn't the administration take action as hospitals are asking for help all around?"
In the outpatient and inpatient buildings of a Level 2 hospital, we saw that the protective clothing discarded by the medical staff every day could stack up to form a hill. One of the staff in the hospital told us that the protective devices were being consumed quite quickly. In order to only use one protective suit per day, a lot of medical staff went into the quarantine zone with a diaper and never came out again on that day. "The protective clothing is really airtight, a lot people got dizzy when they came out (from the quarantine zone)." The doctors of this hospital told us that they had been applying for supplies from the district government. The government delivered supplies every 4 or 5 days, which would be used up instantly. The second batch of supplies that they applied for has not arrived yet.
A manager of a hospital in Wuhan told us that there were two reasons why they did not have enough supplies. First, generally speaking, the city government and the province government would have some stocked supplies in most cases. But they did not give their supplies out, in order to ensure the supply of the newly designated hospitals, such as Huoshenshan and Leishenshan Hospitals. Hospitals usually would not keep a big stock, so they could only ask for help everywhere. Second, Wuhan has been locked down. It takes at least 4 to 5 days to collect materials from other cities and send them to the hospital in Wuhan. Let alone the supplies from other countries. "If the government could give their stocks to hospitals, and then collect more in the name of the Administration, it would be the best choice. But now it's all just the other way around. Treating patients is just like fighting in a war. How could we go through these few days if we did nothing to save ourselves?"
The staff at another hospital answered further questions on how hospital supplies were stored. The infectious diseases department of that hospital ranks top all over the country. A vice chief physician told us that even their department would not keep a large stock of N95 masks and the protective suits, especially the protective suits, which "are not calculated with independent expenses. We pay for every one of the suits that we use. It's on the budget of our department. We do not consume them a lot most of the time, so the hospital will not stock them in particular." He said that most general departments in the hospital would rarely use N95 masks and protective suits. This time they came over to help Wuhan in a group of 6 or 7 people. The hospital gave all of the stocked materials to them, "It's only the fourth or the fifth day since we came here, but the materials have already bottomed out."
A piece of news saying "All kinds of supplies are there. Hospitals with Letters of Introduction can fetch them from the Red Cross Warehouse" spread out on the Internet on Jan 30th.
At around 9 p.m, our reporters arrived at the rumored Red Cross Warehouse. The warehouse was located in the Building A of Wuhan International Exhibition Center in Hanyang. Staff members there told us that they had been operating day and night for a few days already, as the temporary warehouse of the Wuhan Red Cross Society. Donations from individuals and companies all over the country, and even from abroad had been coming endlessly, and were then delivered from there to more than 40 hospitals in Wuhan.
On the site of Wuhan Red Cross Warehouse (by Cai Xiaochuan)
On Jan 26th, the Ministry of Civil Affairs designated the Hubei Red Cross Society, the Hubei Charity Federation, the Hubei Youth Development Foundation, the Wuhan Charity Federation and the Wuhan Red Cross Society as official recipients of donations. Except for targeted donations, all the donations, in principle, should follow the unified allocation of pneumonia control headquarters of Hubei Province and Wuhan City. The official explanation for this decision was to keep the situation under control and to prevent some people from cheating the system. In the opinion of Liu Youping, the vice secretary of China Charity Alliance, this was an unusual approach taken in a particular period of time, in a particular area. The aim of centralization was to improve the efficiency. However, these existing measures failed to solve the shortage of supplies in Hubei in practice.
Ma Jianyin, director of the Center for Charitable and Non-Profit Legal Studies of Beijing Normal University, told us that Red Cross-led donation allocation could indeed improve efficiency in theory, while the targeted peer-to-peer donations from individuals or companies is a less efficient form of donation. This time, however, many hospitals chose to come out on their own and ask for public help (donations). Donors also demanded targeted donations directly to hospitals. They would rather avoid those official donating platforms such as the Red Cross Society. Obviously, both donors and hospitals were unsatisfactory with the efficiency of the coordination and the allocation of supplies.
In an interview, Chen Yun, the vice executive president of Wuhan Red Cross Society, revealed that they had quite a limited number of working staff. There were only 10 personnel in Wuhan Red Cross Society, and a little more than twenty people in Hubei Red Cross Society. All of these people canceled their annual leaves, taking turns to work 24 hours a day, but still failed to manage the supplies well. Even though the Wuhan Bureau of Statistics had arranged thirty more people to take charge of the inventory and registration of the supplies, and nearly 50 volunteers had been recruited, they were still short of working force.
In this context, the mess of supply information also emerged. On Jan 31st, Wuhan Red Cross posted a public announcement on their official Weibo (the equivalent of Twitter in China) account. In this announcement, they said that among the 36,000 N95 masks, which were part of the allocated donations from Jan 22nd to Jan 28th, "16,000 were sent to Wuhan Ren'ai Hospital, and another 16,000 went to Wuhan Tianyou Hospital". Later, they changed the information to "18,000 masks for Wuhan Ren'ai Hospital and another 18,000 for Wuhan Tianyou Hospital". Wuhan Union Hospital, which was really on the frontline against the disease, received only 3,000 surgical masks, and was even not in the official list of supplies allocation.
The Red Cross warehouse which we saw occupied an area of nearly two football fields. The warehouse was divided into two parts, one of which had been filled with all kinds of supply cases and protective tools including masks, gloves, suits, as well as disinfectants, toilet detergents, 'Lianhua Qingwen' capsules (a traditional Chinese medicine) etc. Many of the boxes were labeled "Transfering to xxx Hospital via the Red Cross Society", and the information of the donors. There were not many people transporting those materials. Two or three postal trucks were loading and unloading cargoes.
On the site of Wuhan Red Cross Warehouse (by Cai Xiaochuan)
Just as we arrived at the warehouse of the Wuhan Red Cross, an ambulance also stopped right in front of the warehouse gate. Off the ambulance walked down a doctor in a white uniform, who trotted into the warehouse despite the gatekeeper's resistance. He ran to the office at one corner of the warehouse, with a Letter of Introduction from the hospital. "We came over here upon hearing that there might be something for us. A lot of people in our hospital are working without protections, and there are only two bottles of medical alcohol left ..." He looked anxious, and started to complain in the office. "Sometimes the donations we raised, even from overseas, could not get to us. I heard they were all blocked here." He continued after getting an answer of denial, "My college classmates in Shanghai shipped 10 cases (of medical supplies) to me many days ago, but I haven't received them even till now."
The staff told us, "In principle, the hospital does not accept donations directly. For a targeted donation you need to do it via the Red Cross Society. But if you contact the hospital and donate to it by yourself, the materials will not be sent here because they are not in the Red Cross channel, and will certainly not be blocked."
Some other problems can also be found there. For instance, many donations do not meet the standards. It is a common problem faced by many hospitals that the supplies do not match the standards. Xu Gang, 48, is the head of the equipment department of Wuhan Steel General Hospital. They were already aware at the very first phase of the outbreak.They purchased a batch of protective equipment in advance, but it is also almost used up now. Xu Gang's cell phone has been ringing all the time these days. He said he might get hundreds of calls and thousands of messages per day, many of which were sent from donors. "I don't pay attention to these messages at all. I just know that as a professional I don't even have any access to the equipment. Although the donors are warm-hearted, their donations don't always meet the standards." On Chinese New Year's day, Xu Gang organized several volunteers to transfer materials from Xiantao City. They waited there from the morning till 10 p.m. at night, and finally got the materials they wanted. "When we went there, we were told that we would get surgical masks. But it turned out to be cosmetics masks. We could only put them in the stock because we don't need them."
Despite these problems above, the distrust of the Red Cross Society has undoubtedly become an important problem which is revealed by the donations. Then here comes the question, is the Red Cross Society in such a trust crisis still able to take the gigantic task of coordinating the allocation of supplies? A manager of a non-government volunteering organization told us that many people found them and donated to them because those people did not trust the Red Cross Society, "felt it is not transparent", and were willing to pay the taxes and transportation fees for an ordinary delivery. Some celebrities and their fans organizations also demanded that their donations be directly sent to the hospital. It is because of this kind of suspicion that some private groups simply abandoned the official channel, but tried to find ways to send supplies to the hospital instead.
In order to avoid the official channel, many charity platforms are operating on their own independent of the Red Cross Society. From the material purchasing, logistics to registration and contacting hospitals, they have specific members being responsible for every step, so that the supplies can be quickly distributed after arriving in Wuhan. A private charity platform ran into a really embarrassing problem at the very beginning. One of the donors abroad had a batch of supplies, but they repeatedly stressed that the supplies should not go through the Red Cross channels, and hoped the platform could figure out a solution.
It was not the first time that the platform encountered such a problem. A staff member named Feng Ming told us that overseas supplies, if not going through the Red Cross channels, would be charged not only the expensive transportation fees, but also a great amount of taxes. He mentioned that a generous person from Japan managed to buy over 3,000 masks, and shipped them to China with the EMS service, which cost more than 1,000 RMB. "For masks, the tariff ratio is around 6%, and it is 8% for protective suits. If people use the Red Cross channel, they will be exempted from all kinds of fees, including the transportation and the taxes." However, apart from this, the Red Cross channel requires a lot of certifications and needs the donors to provide all kinds of information, which complicates the donating channel.
A volunteer also mentioned the problem of targeted donations from individuals to hospitals. Since hospitals are always in a hurry, they often directly give donors a photo taken of the public announcement. The donors do not have access to live information from the hospital. As a result, some hospitals will be repeatedly and excessively donated to, while some other hospitals do not get any donations. In order to solve this problem, every time they contact a hospital, they invite one of its doctors into a WeChat group, and update the information of supplies there. Thus they can make sure the supplies will reach those who need them the most. "These are all trivial things. If we could do the statistics at the government level, and then make the information public, it would be easier."
However, logistic channels are constantly shrinking these days. "On Jan 29th we were informed by SF Express that their green channels would only connect to the Red Cross Society from that day on. They would not accept personal orders--namely, their direct logistic channels to hospitals would be closed." Feng Ming mentioned a case in which the donor contacted SF Express the next day. The reply was that even if the donor was willing to pay for the postal cost, he would need to report to the local Red Cross Society and get the verification. Then he might contact SF Express again and ship the goods to the destination designated by the Red Cross Society. "This means the donor would need to go to the Red Cross Society once additionally".
Even though the supplies reached the warehouse, it would be difficult to ensure the efficiency of coordination and distribution. In the warehouse, after communications among several parties, the working staff verified the identity of the doctor who came to ask for help, and allowed him to collect his materials. The workers told us that they made an exception this time. They had been prohibited from doing so, otherwise everything would become a mess. "But they called the Development and Reform Commission, and they really don't have any materials left. It is all about saving lives. We try our best to meet the needs, but sometimes we do not have any solutions". But finding the supplies took a lot of effort. There was a list in the warehouse system to monitor the supplies, but the detailed positions of supplies were not on it. The doctor and the staff went around a corner several times and then finally found the alcohol. Looking for the masks was similarly a tough task.
On the site of Wuhan Red Cross Warehouse (by Cai Xiaochuan)
We learned at the warehouse that a special command team had been set up there, whose members included personnel from the Wuhan Bureau of Statistics, Health Commission and other functional departments, in addition to the leading Red Cross staff. But the two sides are not consistent with each other about the specific allocation of tasks. The Red Cross Society of Wuhan City said in an interview that it was only responsible for receiving supplies. It did not have the power to decide on the distribution and the matching of hospitals. These issues needed to be decided by other departments such as the Health Commission; But a related personnel from the Health Commission said in a telephone interview with us that, the duty of them and other functional departments was only to assist the Red Cross Society.
In the context of such an inconsistency, it is doubtful whether the supplies will arrive in time. "All the hospitals have their own inventory form here. We are distributing according to these forms. We also know that many hospitals are shouting online.But look at these. Are these really what they need so badly?" A person in charge on the site hinted at us to look at the piles of boxes that were stacked up to a person's height around us. He explained that a lot of supplies did not meet the medical standards, so they hadn't given them out at this moment. Those supplies could be later given to people not in key positions. He told us that this was also why the government chose the Red Cross Society to manage the supplies uniformly. "If individuals directly donate to hospitals, the materials could be unqualified or expired. How are we going to manage it if some accidents happen? After we took in charge, there are specialized departments such as the Market Supervision Authority and the Health Commission that can check the products and ensure the quality."
Ma Jianyin, the director of the Center for Charitable and Non-Profit Legal Studies of Beijing Normal University, disagrees with the Red Society's argument that they are short on personnel and energy, He told us that the primary function of the Red Cross is just to respond to major emergencies such as wars, natural disasters, major public health events and so on. Therefore, it should have paid attention to developing their capabilities in normal times, in order to equip itself with corresponding abilities of mobilization and coordination. In some disasters and emergencies such as the Wenchuan earthquake, the Chinese Red Cross Society system did play such a role. But problems emerge again in this outbreak. "The Red Cross should not rely solely on its own staff but rather on mobilization and should be able to mobilize a large number of volunteers (who should be trained in normal times), to coordinate resources in the Red Cross systems in the province, to communicate with Red Cross systems outside the province, including the Red Cross Society of China, so on so forth."
"As for coordinating the demand and the supply, building the platforms, to tell the truth, they should have the capabilities to do these things." In fact, there are a lot of NGOs doing it right now. They can absolutely be open to and work with each other. Ma Jianyin told us that it is inappropriate to limit the task of receiving donations to these five institutions out of inertial thinking in such a special period. (The government) can consider special operations, integrate social forces and open private channels.