Click play to listen to the story produced by the Seattle Globalist for KUOW Public Radio.
It all began with a man and a suitcase. It was the early-1990s and Carol Glenn was living the “sad, exhaustive nightmare,” of working as a nurse during the height of the AIDS crisis.
“You hit the door running when you got there and it never stopped,” Glenn, now 65, remembers. “It was IVs and blood transfusions and contamination treatments and grief and horror shows.”
Then one day, in the midst of that chaos, Glenn saw a man stuffing a suitcase full of medications next to a scale in the hallway of Harborview’s Madison Clinic.
That man was Dr. Jorge Sanchez. He worked at the clinic but was traveling back to his home country of Peru where medical supplies, especially HIV/AIDS treatments, were scarce.
Glenn says she immediately responded by gathering up extra medications she had on hand. “I said, ‘I have some Bactrim,’” Glenn recalls, referring to an antibiotic used to treat pneumonia commonly contracted by HIV-positive patients.
What she didn’t know at the time was that this one act would turn into an operation that moved — by her own estimate — millions of dollars worth of HIV/AIDS treatments, general pharmaceuticals and medical supplies around the world over the course of almost two decades.
It was a controversial practice known as international drug recycling, and it would make her a hero to some, a reckless nuisance to others, and would ultimately cost Glenn her job.
And while today Glenn’s actions evoke politicized debates over global inequality, a broken health-care system and the continuing impacts of HIV/AIDS, she says at the time she was simply trying to get otherwise unwanted and often expensive drugs to needy patients.
At first there was Peru via Sanchez and a friend in South Africa. But Glenn was moved by accounts from medical professionals returning to Seattle from countries fighting AIDS with virtually no weapons. She imagined the horror she saw daily in her own clinic unfolding in resource poor communities around the world.
A code was developed. It was called “Bringing Carol Her Lunch” — and people starting bringing her their unused drugs in brown paper bags with “Carol” written on them.
Some of these people were patients returning unused medications, others were family members — aware of the cost and rarity of HIV/AIDS drugs — returning meds after a loved one had died. Sometimes doctors would give her meds that were recalled because the name had changed making old packaging incorrect.
Word spread through global health, aid and development circles, and Glenn became a known point person for collecting everything from antiretrovirals and post-exposure prophylaxis (also known as PEP, a series of drugs taken to help prevent HIV infection after someone may have been exposed) to latex gloves and even prosthetic limbs.
Glenn never traveled to the countries she donated meds to herself but for the almost 20 years she worked for Harborview’s Madison Clinic she passed on these drugs and supplies — which often would have been destroyed otherwise — to health-care workers traveling abroad to clinics and hospitals where such treatments were desperately needed.
“We knew it was illegal…but nobody said anything about it.”
There is documentation that her underground network expanded to include Ethiopia, Kenya and Somalia. She says she also worked in Cuba, Rwanda and Sudan.
“What she gave us was a hope for people that were just dying without their medication,” says Sanchez, now an HIV/AIDS researcher in Lima, Peru, and an affiliate associate professor with the University of Washington Department of Global Health. “I remember bringing full luggage with medicine for people.”
Sanchez says that he personally ferried drugs that Glenn provided throughout the 1990s and donated them to an AIDS clinic in Lima called Via Libre.
“Peru started to provide (AIDS/HIV) medicine in the year 2004,” says Sanchez. “Can you imagine how long [Glenn’s] help made a difference in this country?”
Glenn may have been making a difference, but she was operating on her own and what she was doing wasn’t sanctioned by the clinics and hospitals she worked for.
“Medical practitioners have been doing this a long time,” says Eric Schmidt, who teaches bioethics and law and a class on medical liability issues at the Seattle University School of Law. “They’ll go volunteer in a clinic in Central America somewhere and they’ll take … a bunch of drugs with them to these places where you couldn’t get access.”
And though at first glance this may seem like a purely humanitarian act, Schmidt says there are legitimate concerns over liability and quality of care.
“One [issue] that has been raised is what I would call the ‘second class citizen concern,’ ” says Schmidt who explains that many ethicists worry that the lack of regulation, control and accountability in international drug recycling means that poor patients in foreign countries may be getting expired, poorly stored and improperly administered drugs.
Glenn says she was always careful to only give medications and supplies to medical professionals or to patients who had a prescription. But she acknowledges that there were risks in what she was doing and freely admits that she often recycled meds that were expired or near expiration, believing they remain potent long after their official expiration date.
“It was illegal,” says Glenn from her Shoreline home. “We knew it was illegal — although there were literally probably well over 100 people participating — but nobody said anything about it.”
Actually, it’s more of a legal gray area. While it is illegal to redistribute drugs outside of existing medical systems within the United States (something Glenn also admits to having done), the law doesn’t apply to redistributing drugs in other countries, which have their own varied laws and regulations regarding the practice.
What’s more, drug recycling of this kind was in violation of Glenn’s nursing license.
In the end, it wasn’t her critics that brought down her humanitarian drug trafficking ring. It was a fan. Glenn says she had been working for years with Michael Chung — a doctor at an AIDS clinic in Kenya.
According to Glenn, Chung gave a speech at World AIDS Day at the University of Washington in late 2009. In it Chung outlined the drug-recycling program and thanked Glenn for all the lives she’d saved, presumably oblivious that he was publicly revealing the scope of her operation.
Chung declined to comment for this story.
A letter from her employer, Harborview, from October 2010, indicates that Glenn was formally warned to stop drug recycling on at least two occasions. Glenn, by her own admission, did not stop. She says she couldn’t face cutting off needy patients to save her own job. Glenn resigned from her position at Harborview in December 2010.
Harborview also declined to comment for this story.
The State of Washington Nursing Commission investigated a complaint brought against Glenn by Harborview but decided to take no action as Glenn’s nursing license had expired by the end of the review period and Glenn, bogged down in controversy, had no intention of fighting to renew it.
Ironically, the investigation provided some of the most detailed evidence of Glenn’s impact via letters of support.
One tells the story of a “husband, father, breadwinner and … small business owner” in Nairobi whose life was saved by a drug cocktail not commonly available in Kenya. Another describes how Glenn provided a “short-term bridge” for two men who couldn’t afford the copay on their HIV medications.
But one story captures all of the heartbreak and hard choices Glenn came to know all too well in her work.
“My sister-in-law contracted HIV through a blood transfusion while delivering her fifth baby in a rural clinic,” says a letter signed “A grateful sister-in-law.” The writer explains the hardships of accessing AIDS medication in a country ravaged by war and often discriminatory toward those infected with HIV/AIDS. She describes how Glenn shipped medication in the camouflage of prenatal vitamin bottles to the Somalia capitol Mogadishu then by car 30 kilometers to the correct village.
“If you have the ability to make a difference or save someone’s life, and you withhold that medication, to me that’s doing harm.”
A second letter from the same family, this one signed “anonymous,” reveals that the HIV infected woman died but that Glenn’s medications allowed her to live long enough to find homes for all of her children.
It ends, “The family is forever grateful to ‘the nurse from Seattle.’ ”
Since then she has spent a lot of time in her terraced backyard in Shoreline and hanging out with her small army of Chihuahuas.
She says the past few years have been hard — adjusting to a retirement that came too early and being shunned by many former co-workers and friends for what she considers her life’s work. But she wouldn’t have done anything differently.
“The first thing in the Hippocratic oath is ‘first do no harm,’ ” said Glenn. “If you have the ability to make a difference or save someone’s life, and you withhold that medication, to me that’s doing harm.”