9 June 2012

Uganda: Solutions to Fake Medicines


I recently flew to Uganda for vacation shortly after my annual routine medical check-up with my primary care physician. The physician prescribed three different medicines for me to take as a result, which I carried in my baggage.

Probably because I used Emirates Airlines traveling via Dubai and my fairly large suitcase, Customs agents at Entebbe International Airport pulled me out for inspection. They asked me where I was from and what I had in the suitcase, I told them California, U.S., on vacation to Uganda and the suitcase had my personal belongings and gifts for my relatives. Unsatisfied with my answer, they x-rayed my suitcase. The three medicine bottles attracted the agents' attention.

On opening the suitcase for detailed inspection, they asked me what the medicines were for. I told them for my personal use. The four agents almost asked in chorus, "How can you have three bottles of medicines for your own use?" I was perplexed but remained calm. I picked the bottles individually to show them that each was clearly labeled with the medication names, my full names, address, phone number and dosage; my physician's full names and phone number; and the dispensing pharmacy's full name, address and phone number. One of the bottles actually had multi-vitamin and mineral supplement pills.

Unconvinced by my explanation, the agents maintained I was bringing in the country illegal drugs for sale. I asked them if any one of them was a medical professional or pharmacist, a question they avoided to answer, insisting that one person could not have three bottles of pills for his personal use. At this point I asked the agents to call my personal physician and dispensing pharmacy in U.S. for verification. I also asked to call the U.S. Embassy in Kampala. Only then did the agents allow me to exit customs control.

I drew two key conflicting conclusions from that experience: First, it showed that the agents were somehow vigilant about policing for illegal and fake drugs entry into the country. Secondly and more disturbing, the agents appeared to be clueless and lacked the tools and knowledge to effectively enforce illegal and fake drugs policing. For instance, their ignorance about modern health care needs and knowledge of medicines made them insist that one person could not have three bottles of tablets for his/her own use, let alone the U.S Food and Drug Administration's policy of prescription drug labeling. It was like a motor mechanic tasked to diagnose a sick patient.

So when we see 30 percent of fake malaria and HIV/AIDS medicines flood the Ugandan market, according to the National Drug Authority (NDA), we need to ask ourselves:

How well trained and qualified are the customs agents policing the border entry points for fake drugs? Do we have enough NDA personnel at all border posts?

Why doesn't the NDA that has the constitutional mandate to ensure that Ugandans get safe medicines purchase and distribute to all border customs posts The Merck Manual, the world's most widely referenced, comprehensive and up-to-date handbook of medicines, disease diagnosis, symptoms and medical side-effects commonly used by hospitals, pharmacies and medical schools? Each costs only US$80 (Sh. 196,000).

Does the NDA realise that its lackluster supervision of drug stores and pharmacies and its failure to close illegal ones and prosecute/imprison their owners as a deterrent to others is actually doing more harm to the health of Ugandans?

Factoring in corruption, how many of the NDA personnel and customs agents look the other way after traffickers of fake drugs give them 'kitu kidogo?'

Until the NDA, police, and the ministries of Health and Local Government come to the realisation that only qualified pharmacists but not every nurse, medical assistant or doctor are authorised to open drug stores and dispense medication to patients, the scourge of drug resistance and deaths from fake medicine concoctions from quack pharmacists and unlicensed drug stores will continue to grow.

Vivian E. Asedri is a medical information technologist based in San Diego, California,

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