Shipments of Direct Relief-provided medications are helping stabilize care at Edward Francis Small Teaching Hospital, or EFSTH, where shortages once forced staff to improvise, according to the hospital’s chief medical director.

Since December 2024, Direct Relief has sent 13 shipments of medical aid to EFSTH. An additional shipment worth $2.9 million is staged for delivery, including antibiotics, diabetes medications, cardiovascular drugs, and mental health treatments.

The hospital is located in the Gambia, mainland Africa’s smallest country, which is home to about 2.7 million people. It is bordered on all sides, except for the coast, by Senegal and stretches narrowly inland along both banks of the Gambia River. The hospital is located in the capital, Banjul, and the facility is the country’s only teaching and referral hospital.

“It’s incredible, and it’s coming at a really great time,” said Dr. Mustapha Bittaye of Direct Relief’s medical support. Dr. Bittaye, is the chief medical director at EFSTH. Previously, he served as director of health services in the country’s Ministry of Health.

Medication access has been a challenge in the country. A deadly 2022 event triggered sweeping regulatory scrutiny, slowing imports and complicating the already fragile supply chain for essential medicines.

“Getting drugs into the country became much more difficult, including more checks, more delays,” Bittaye said.

Those constraints compounded existing shortages in a public health system where most patients rely on heavily subsidized care.

In 2025, Bittaye’s hospital was onboarded as a Direct Relief partner, allowing it to receive a supply of medical aid to support patient care.

Previously, hospital staff were sometimes forced to source drugs from private retail pharmacies outside the hospital, often at inflated prices.

“It caused a lot of problems,” Bittaye said. “Patients couldn’t get what they needed, and private pharmacists were making a lot of money.”

The supplies have been easier to import under the new stricter post-scandal controls, Bittaye said.

“U.S. drugs are easier to get now, and they’ve been great,” he said.

Jeffrey Samuel, Direct Relief’s regional director for Africa, said the organization prioritized EFSTH because of its national role as the country’s only teaching and referral hospital.

“Strengthening EFSTH really means strengthening the country’s ability to deliver care more broadly, especially for more complex cases,” Samuel said.

Support has included both medicines and infrastructure, including an oxygen system piped directly into hospital units, he said.

“That kind of investment is pretty foundational – it changes what clinicians are able to do in real time and has a direct impact on patient care,” Samuel said.

The on-site oxygen plant was completed early last year. Oxygen is used throughout patient care in hospitals, and the cost previously strained the hospital’s budget, sometimes even exceeding monthly revenue.

What began with EFSTH has expanded to additional hospitals and collaboration with the Ministry of Health, reflecting a broader systems approach, he said.

“At the end of the day, our goal is not just to deliver products, but to support the broader systems that make care possible, whether that is medicines, infrastructure, or working closely with national partners,” Samuel said.

The impact extends beyond a single hospital. EFSTH has shared information about the shipments with the Ministry of Health and other facilities, helping expand access nationwide.

Even with improved drug availability, major gaps remain. Shortages of basic consumables such as gloves and gowns persist, and the hospital lacks key heavy medical equipment. Transportation and cold storage constraints have also limited the use of some donated supplies, including temperature-sensitive medicines.

For now, Bittaye said the steady flow of medicines, along with the oxygen plant, is allowing the hospital to shift focus to other urgent needs, including sanitation improvements for patients.

“Now that some of those gaps are filled, we can start addressing other problems.”