Monrovia - Martha, a vegetable vendor at Waterside Market, has an upset stomach.
So, grimacing, she signals a man who sells medicine from a transparent plastic bucket.
He gives her tablets of metronidazole (Flagyl), a prescription-only antibiotic.
Drug peddlers, hawking everything from cough syrups to powerful painkillers, antibiotics, and syrups are easy to find in this market.
“We buy most of the medicines here, unless you have a very serious sickness,” Martha says.
“Issues like stomach upset, headache or general pain, you just buy the medicines here.”
On the other side of the market, makeshift stalls display roots, sticks, tree bark and powders unregulated traditional remedies sold by traditional healers.
Signboards announce cures for various ailments, from sexually transmitted diseases to high blood pressure.
The open sale of drugs both traditional and pharmaceutical by unregistered outlets is a major concern in Liberia.
A constant shortage of medicines in government hospitals and clinics has stimulated the growth of informal drug markets all over the country.
Meanwhile, the sale of traditional medicine, which often comes in the form of unprocessed roots, leaves and other products, is completely unregulated.
It is not hard to find one of Liberia's roving drug salesmen Roland has a spot just a few kilometers near the police checkpoint Waterside, Monrovia, where FPA reporter met him. He wore a backpack along with a bucket where he was instructing his small brother who is to run the table tablet business.
Both backpack and bucket were full of unmarked plastic bags of pills that he said were painkillers and malaria drugs. Roland said this is not what he had in mind for his life when he graduated from university.
He currently has a BSc in Biology and Chemistry from the Mother Pattern College of Health Science. "How does the government expect us to survive when there is no job? So I do this, moving from villages and towns and sell these drugs to the people," Roland explained.
"At least we are helping government. Some of the places we go, there are no health facilities. So I think we are a help." But it is a crime to sell medicines in the street without a license. Inspectors from Liberia's Pharmaceutical Board have been combing the countryside looking for drug peddlers like Roland this year. Chief Pharmacist of Liberia Reverend Tijli Tarty Tyee Sr. said the pills and treatments these peddlers sell are expired, damaged by sun or humidity, or just fake. "Medicines sold in this manner will not have the basic ingredients that will bring about cures and as a result of that," Tyee explained, "people taking the medicines, there is a potential of having microbial resistance to the medicines. When we have resistance to our imported medication, then we are in a very serious, serious situation." He said he understands that people need medicines and they need them cheap. "They want to have a shortcut in getting medicines but that shortcut is dangerous to them but this is a global problem that needs to be tackled," Tyee said.
The selling of traditional medicines is common in Liberia, but government regulators are unable to control the industry. Medical experts say traditional medicines can cause health problems.
Liberia Medicine Health Regulatory Authority, a subsidiary of the Ministry of Health is mandated to ensure the quality, safety and efficacy of medicines and health products used in Liberia but unapproved drugs are still widely available.
Currently Liberia has more than 150 pharmacists and over 300 pharmacies in the country.
The LMHRA though have pointed out the ABEER pharmacy as high risk pharmacy for expired and fake drugs (an Indian Owned) but it is still operating with over five substations in Liberia.
In communities there are drugstores and vendors usually operate them illegally or without trained medical personnel, mostly in slum communities.
We buy most of the medicines here, unless you have a very serious ailment. Issues like stomach upset, headache or general pain, you just buy the medicines here. Gomah, a hair stylist who buys prescription-only drugs from informal vendors
Occasionally, LMHRA carries out sweeps in partnership with the police to rid the market of illegal drugs. Sometimes, traders are let off with a warning.
Repeat offenders are arrested but no prosecution yet for those caught including selling drugs without a license, selling prescription-only drugs to people without prescriptions and selling unapproved drugs.
The chief pharmacist told FPA that budgetary constraints remain a problem in enforcement to curb the drugs entering the country illegally. Right now, LMHRA solely rely on the custom officers to curb the import of counterfeit or fake drugs, he says.
Slipway residents say a lack of medicines in government hospitals pushes them to seek traditional remedies or buy medicines from street peddlers. That’s faster than going through formal pharmacies or clinics, they say.
This community with over 10,000 inhabitants has only a clinic and no pharmacy, but a lone drugstore.
“All you get from a clinic or hospital is a prescription,” Charles Brown says. “So why waste my time when I can simply buy the medication anywhere?”
An inconsistent supply of essential pharmaceuticals and medical supplies has been a problem for a long time.
Recently, delegates from the ECOWAS Parliament Joint Committee on Health and Social Service, Trade, Customs and Free Movement were in Liberia attending a week-long meeting to discuss ECOWAS policy on the fight against Counterfeit Medical Products and expired Products and how Parliamentarians can contribute toward implementing and improving the policy.
Liberia’s House Speaker Emmanuel Nuquay, called for tougher punishment against individuals bent on polluting countries in Africa with counterfeit medicines to provide economic empowerment for their citizens to alleviate poverty and illiteracy in their region.
The Speaker said survey conducted in 2008 by the West African Regional Health Program, states that the trade of counterfeit medicines in Liberia stands at 60%.
Quoting the same report, the Speaker named; Nigeria and Ghana as the Major hubs for counterfeit medicines, and Guinea serves as the conduit for counterfeit and illegal medicines entering Liberia through border in Ganta, Nimba County.
A 2013 government report attributed that to inadequate funding, weak regulatory framework and weaknesses in the procurement, distribution logistics and storage management systems.
Abraham Dorley an herbalist says more regulation will help ensure that fake or untrained herbalists don’t sell traditional medicines.
Meanwhile, the street-side sale of drugs is a booming business.
Mathews, a trader who sells medicines in Slipway, downtown Monrovia, says the drugs are in high demand.
“People get sick every day, and most of them say there are no medicines in clinics,” says Matthew, who doesn’t have any sort of license to sell the medicines.
Matthew says he only sells painkillers, syrups and prescription drugs. He knows that it’s illegal to sell the drugs on the street but says he’s never been arrested.
The lack of regulation of traditional remedies is a separate, but equally serious, problem.
Also the Liberian Drugs Enforcement Agency (LDEA) arrested a huge quantity of expired pharmaceutical drugs in Monrovia following a tip-off.
The expired drugs, according to the LDEA, were discovered and arrested in an unfinished building in the Johnsonville Community outside Monrovia.
The number of drugs arrested was 75 cartons of several types of expired and counterfeit drugs such as; Vermox, HIV test kit, Amodiaquine, Septrin, Gentamycin, paracetamol, and sterilized water.