PAYNESVILLE, Montserrado – Boima D. Dougba remembers well the last time he saw a child on death’s door because he had been given the wrong medicine. The 5-year-old had malarial symptoms. But instead of going to a clinic, the mother’s first stop had been a pharmacy.
By Nemenlah Cyrus Harmon with New Narratives
“She took the child to a drug store, a place where medicines are sold and bought without prescription,” said Dougba, a physician’s assistant at the Best Care Medical and Diagnostic Clinic, health care center in ELWA Community.
Dougba, who graduated in 2016 as physician’s assistant from the government-run Tubman National Institute of Medical Arts, found the child had been given a wrong dose. And the medicine was likely missing key ingredients.
“If the mother did not seek treatment at a professional health facility like the Best Care Medical the child would have died,” Dougba said.
Dougba is one of many frontline medical staff in Liberia calling for closer monitoring of the importation of medicines into the country. This comes in the wake of last year’s tragedy in Gambia where 77 children died after receiving contaminated cold medicine imported from India.
The World Health Organization estimates 1 in 10 medical products circulating in low and middle-income countries are either substandard or falsified. This means that people are taking medicines that fail to treat or prevent disease. Not only is this a waste of money but substandard or falsified medical products can cause serious illness or even death.
Following the deaths of the Gambian children, Liberia immediately suspended official imports from the Indian drug maker Maiden Pharma but government officials conceded there is no capacity to police all imports. The World Health Organization did not find the tainted drugs outside Gambia but if they did come to Liberia it is likely they would have gone undetected.
There’s no way of knowing how many drugs coming into Liberia are falsified or substandard. But experts say it is likely a lot.
“The medications that are coming into the country, where they are coming from? Where are they being produced? Whose making them?” asked leading infectious disease specialist Dr. Dougbeh Christopher Nyan. “Are they being tested to prove that what they claim is actually accurate? In the United States, the Food and Drug Administration does it. Even Ghana does it – such a medicine can’t pass the Ghana regulatory system for example. But Liberia is another story.”
Most official imports are being tested according to Dr. Flomoku G. Miller, Technical Advisor for the Liberia Medicines and Health Products Regulatory Authority (LMHRA), the government agency tasked with ensuring only safe, effective and good quality medicines reach the Liberian public. LMHRA is mandated to register all products for import and issue licenses or permits to people or organizations importing them.
Samples are tested at the quality control laboratory in Kings Farm, Careysburg. But the facility lacks the equipment, trained personnel and funding it needs to test all aspects of the medicines and meet some international standards according to Dr. Miller.
The Ministry has not received any reports of fake or tainted medicine but James O. Beyan, Deputy Director of the Supply Chain Management Unit within the Ministry of Health’s Department of Pharmaceutical Services, agreed that, despite the strong policy on health regulation, the political will to enforce it is lacking.
“For example – the donation guidelines to evaluate drugs coming into the country from donors. Those guidelines have all of the ingredients to ensure that drugs are not substandard or expired, but the document has expired,” said Beyan. “It was designed for 5 to 6 years go. It needs to be revised to meet current day reality.”
The bigger problem is drugs coming in illegally. The government has almost no capacity to police that. In September a team from the LMHRA discovered large consignments of fake and low-quality medicines on sale in the Jenne-Wonde market in Grand Cape Mount County and the Sasstown Market in Bomi County. A violent scuffle broke out between government officials and the drug peddlers. LMHRA officers seized the drugs but the peddlers escaped.
When drugs come in illegally they usually find their way to “bucket boys” sellers who peddle medicine from bins in the streets.
“Medicines are poison if they are not taken correctly,” said Dr. Miller. “People should stop purchasing from bucket boys or medicine peddlers. If we can be successful through our campaign to convince the population not to buy from bucket boys, they will not have means to smuggle medicines in the country.”
The awareness campaigns are working according to bucket boys in Monrovia’s densely populated Red Light Market. Business has dropped dramatically said Jeremiah King Duu Jr., a medicine peddler here since 2008. He said many people used to buy from him and his colleagues on a daily basis. “They are discouraged due to the government’s campaign that they should not buy medicines outside, it’s sometime substandard,” King Duu Jr. said.
But the peddlers will not give up easily. The staggering poverty in which most Liberians live – and which has only got worse in the last two years – makes the cost of a doctor’s visit unthinkable and forces many to take the cheapest option even when they know it is risky.
“There are people who still come to buy from us,” said King Duu Jr. “They can praise us that we are patient with them to identify their medicines as compared to a pharmacy.”
King Duu Jr., a father of three, claims he is a reliable seller who learned about medicines from his father, a medical doctor and from study at a nursing school. He rejects assertions that peddlers sell substandard medicines claiming his come from registered pharmacies.
Moses Scott is another drug peddler. He supports two children. Like King Duu Jr. he would like to see the government regulate and train bucket boys rather than drive them out of business. They don’t have other job options, he said, and there are customers who need them. “What the government is saying is good, but for emergency cases, like for people in rural areas, they have no means of reaching hospital quickly. So if we the peddlers don’t reach them, their conditions get worse,” Scott said. “Sometimes they die on their way to hospital. We can help in that and save lives.”
Those claims are concerning for experts such as infectious disease specialist Dr. Dougbeh Christopher Nyan. He is part of a global chorus of experts raising the alarm about mis-prescribing of antibiotics by untrained peddlers and pharmacy staff. Misuse of antibiotics is a major problem around the world, making antibiotics less effective and leaving patients vulnerable to other infections. In Liberia they are handed out freely. Dr. Nyan warns antibiotics should never be taken without a doctor’s prescription.
For most Liberians getting safe medicine continues to be a dangerous lottery.
This story was a collaboration with New Narratives as part of its Investigating Liberia project. Funding came from the US Embassy of Liberia. The funding had no say in the story’s content.
