Prelude
On Thursday, 2 days before our scheduled departure for the medical mission, I received an email from Terry Dupont, our missionary host in Nicaragua. He had met with MINSA, The Nicaraguan Ministry of Health (Ministerio De Salud), who had informed him that we could bring in no drug that was less than 6 months from expiration.
The reason we are able to have so many drugs available to us at very little or no cost is that they are nearing expiration and we take delivery just weeks before leaving the country with them. 75% of the drugs we packed weeks earlier did indeed have less than 6 months before expiring.
About expiration dates; drugs are required to have an expiration date by the FDA. This is the date that the manufacturer will guarantee absolute, 100% full potency and safety of the drug. A study by the FDA, however concluded that most drugs are perfectly safe and retain their potency even 15 years after their expiration date. There are some exceptions, of course, for specific drugs like tetracycline, but we didn’t take any of those.
So, with our drugs already in the hands of the travelers, spread out over 2 states and with just 2 days left before departure, there was no way to get together and pull out the medicines with the offending expiration dates. I wrote our host and told him of our situation and that we would just take our chances at customs. The worst that could happen would be that all of our medicines would be confiscated at customs which would shut down our clinic. Leaving behind 75% of our medicines would have the same effect, so we became smugglers or humanitarians depending upon your point of view.
Departure and Arrival
On Saturday, 2/18 we began meeting at the airport at 1:00 PM for a 3:00 flight, but as the first few people arrived, we were confronted with new problems – some of our totes full of drugs were over the 50 pound limit.
We began shifting drugs around between totes to keep each one under the limit. Right in the ticket line, bottles and packages of drugs were all over the ground being moved about, weighed, moved and re-weighed. The agents were strict about the weight limit – we were not even allowed ½ pound over. In the end, we spent over $500 in excess weight charges to save leaving behind many hundreds of dollars worth of medicines. Of course it may have been money wasted if all the drugs were to be confiscated upon our arrival.
We finally boarded our flight to Houston after a short delay in loading luggage. However, upon lifting off, we were confronted with strong headwinds and our flight was late in arriving. So late, in fact, that our plane to Managua was held for us at the gate as we raced through the airport. (We’re 45 minutes late).
We board the plane, but the captain announces we are overweight and must de-board some passengers and luggage. We finally take off and wave good bye to some of our totes sitting on the tarmac. (We’re 75 minutes late) Strong headwinds again, but we finally arrive in Managua. (Now we’re almost 2 hours late)
In customs I hand over our drug inventory (which does not include expiration dates) to the MINSA representative who says thank you and disappears. There are no inspectors on duty, no one at the exit to conduct random luggage inspections… we simply walk out into the Managua night with all our totes, still sealed, never even noticed. It’s as if some Jedi Knight waved his hand and said “these drugs are OK, let them through”. Should I have expected any less?
We will later receive a call from MINSA asking us to turn in all of the Flucanazole tabs . No reason given and we will ask no questions. 4 totes did not come in, but we have everything we need to start our clinics without delay.
There is excitement on the bus as we travel 90 minutes in the darkness to the missionary’s home in Leon. There are several who have not been here before, a couple who have never been out of the country before and at least one of us has never before flown. The rest of us, knowing something of what to expect, are anxious to get organized and on with the task at hand. The foreign sights, sounds and smells all around us elicit a heightened awareness of our surroundings, nostalgia for some, a comfortable familiarity for others, and all in all, a feeling of anticipation.
We finally arrive, make introductions all around, find our beds and drift off. 18 hours ago we left snow on the ground and now we are turning on fans trying not to stick to the sheets from sweat. What an amazing world.
