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Thursday, September 18, 2014
Poindexter Sama and Jessica McDiarmid
- Bubble-wrapped pills are scattered across the crude table in a busy market beside crumpled boxes of lubricant, paracetamol and anti-fungal powder.
A young man approaches and mutters a few words. The proprietor shuffles through the piles of sexual aids that cover the table – generic viagra, ‘man-woman’ cream (lubricant), dubious-looking condoms – before cutting a section containing two antibiotic capsules off a sheath. He hands them over, collecting in return 600 Leones, the equivalent of about 15 cents.
So-called “drug peddlers” ply the streets of cities and villages across Sierra Leone and much of West Africa, selling pharmaceuticals, often counterfeit or substandard, at reduced rates.
Strides have been made over the past few years to ensure drugs are safe and effective, but medical practitioners still cite these drugs as one of the largest obstacles in their fight to save lives. In Sierra Leone, still struggling to overcome the devastation of an 11-year war that left the nation in ruins, efforts remain beset by hurdles such as weak infrastructure, a lack of regulatory regimes in neighbouring countries, and few resources stretched in many directions.
Pharmacies in Sierra Leone are regulated under its Pharmacy and Drugs Act. Enforcement has been stepped up substantially in recent years, but what to do about those peddling on the streets remains elusive.
He’s been selling since the war – when the formal healthcare system disintegrated and peddlers were the only option – and says he’s never had a complaint about his products. He recommends drugs and describes how to take them, though he can’t read most of what’s written on the packaging.
Keai says police frequently harass drug peddlers. Occasionally, authorities seize his drugs and arrest him. Sometimes he even goes to jail for a while.
“But there are no job opportunities, so even if we are arrested, we’ll start selling the drugs again when we are released,” says Keai. “We are doing this to survive.”
The registrar of the Pharmacy Board of Sierra Leone, Wiltshire Johnson, tasked with regulating drugs in the country, says about half the drugs sold in Sierra Leonean pharmacies three years ago were fake or substandard. Now, Johnson estimates more than 95 percent of products from pharmacies tested by the board are real.
Johnson says Sierra Leone is left vulnerable, however, because while it has beefed up its monitoring and enforcement of the formal sector, the country imports all its pharmaceuticals – some 30 to 40 million dollars worth a year. A crackdown on formal imports has been largely successful.
“The people involved in the formal sector realise you can no longer bring bad drugs to Sierra Leone,” says Johnson. “Our big challenge is the informal sector, the illegal sector, the drug peddlers.”
Liberia and Guinea, which neighbour Sierra Leone, have virtually non-existent drug regulations. The borders between countries are porous, allowing traffickers to move supplies in with relative ease, and customs and border officials are poorly paid. It doesn’t take a large percentage of profits from a lucrative drug trade to convince someone to overlook a few cartons of packages of – supposedly – penicillin.
Johnson says the pharmacy board works with police and the judiciary to enforce the pharmacy act, but argues that tougher punitive measures are needed to deal with drug peddlers.
The current law tops the time in prison at two years and the fine at five million Leones, about 1,200 dollars.
But the actual punishments meted out are usually far lower – between 100,000 and 300,000 Leones, or 20 to 60 dollars – doing little to discourage the practice, says Johnson.
“It’s a mafia, they just pay the monies and go back to the street and sell,” he says. “Tougher penalties are the only way we can really change.”
The regulatory laws on pharmaceuticals are currently under review.
Umaru Kamara, a pharmacy technician at Connaught Hospital in Freetown, says many, if not most, of the drugs for sale on the streets are substandard or fake.
It’s a regular occurrence in the hospital for staff to notice that medication – which patients will buy outside for cheap prices instead of at the hospital pharmacy where drugs are sold on a cost-recovery basis – isn’t working. Investigations reveal that the drugs the patients bought aren’t what they should be.
The dangers of substandard and counterfeit drugs are many, says Kamara. For example, fake antibiotics lead to worsening infections and complications, while substandard antibiotics cause drug resistance.
“(Drug peddlers) either give the wrong dose, give the insufficient dose so it will have no effect, or give an overdose,” says Kamara. “They can kill thousands of people.”
While education campaigns seek to inform the public of the risks of fake or substandard drugs, poverty gets in the way. Drug peddlers often offer lower prices and will sell a single dose, rather than having to buy a course of treatment all at once.
“Drug peddling is directly poverty related,” says Johnson. “It’s a social issue of survival.”
From the peddlers on the street to the patients buying their products to the people smuggling cartons of weak amoxicillin through the jungle, crippling poverty – some 70 percent of Sierra Leoneans live on less than one dollar a day – means there are few other options.
In April of last year, Sierra Leone introduced free health care for pregnant and nursing women, and children under five, including free medicines, in a bid to improve one of the world’s highest rates of maternal mortality and infant death. The ambitious program has seen a huge rise in the number of women and children accessing treatment, but drug supply remains a challenge, driving many to the streets to find medicines even when they’re covered by the program.
“You can have all the doctors, all the free health care, but if you don’t have the medicines, people are still going to die,” says Johnson.