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MEDICINES

A Nation on Drugs

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Medicines are extremely dangerous. Unnecessary use, dispensing without 
prescriptions as well as inappropriate dosing are serious global problem

Lax enforcement of regulations with the resulting proliferation of dispensing
 chemists which are at liberty to do as they wish has made Kenya, 
quite literally, a nation on drugs.

It’s my first visit to one of Kenya’s larger towns and I am amazed by the sheer number of chemists. On every street, you find them besides and opposite each other. You would think the competition is very tight. Yet none of them doesn’t have at least a few people buying drugs at the counter. Some of the larger chemists have people waiting to be served. At the counter, drugs of all kinds change hands as the cashiers struggle to return change. Overcome by curiosity, I decide to walk into one of them, the one with a queue, to find out what really happens there.

As I wait in line, I hear all manner of requests from the buyers. Some ask for specific medicines. Others explain their problems and ask which medicine is the best for them. In every case, medicines is passed over the counter, sometimes several different types to the same person. They range from those of minor colds and allergies to to some which simply shouldn’t be dispensed without a prescription.

Chemists have promoted drug misuse and its attendant ills. The World Health Organization recommends the removal of perverse financial incentives to improve rational drug use.

And a prescription is the one thing that doesn’t matter here. A few times the person selling asks for a prescription. If none is produced, as in the majority of cases, the medicine is dispensed anyone. I witness people buying some very dangerous drugs, getting very shallow explanation on their use and walking home to deal with whatever happens to them.

This is something that seriously worries me. It worries me not because do not know it happens but because of my understanding of the risk this poses. Self-medication is a serious risk to people’s health and a frequent cause of death. Many people come to doctors with complications caused by medicines.Usually, they will have obtained the drugs from chemists where they are dispensed without any prescriptions. This is a problem which people have been warned against but they for some reason seems to be getting worse. It is especially so when one considers the dire consequences of drug toxicities.

Of the cases I have dealt with, one stands out. On a chilly evening I was called to the ward to handle an emergency. The description of the patient was dire. On arrival, I found a middle-aged woman bleeding from the mouth and nose. She had difficulty breathing and was unable to speak coherently. I recognized her because she had recently been admitted in this ward. She was accompanied by her daughter who explained that the symptoms started a few days after starting the medication that had been prescribed during discharge from the previous admission. I assessed her thoroughly trying to find other possible causes of the problem. I couldn’t simply assume it was a severe drug reaction. Any doctor gets sick at the thought that a drug they prescribed has put someone at the blink of death. I was actually hoping to find other causes of the condition. Finding no other cause and after stabilizing her, I asked to see the prescription and the medicine itself.

The daughter handed me the prescription and said that her mother had finished the dose.

“NO. There is no way she could have!” I said.

“She did. She used it as she was told at the chemist where she bought it.” The daughter said.

The prescription clearly said that the medicine should be taken for six weeks. It had been only six days since she left the hospital! I was in shock.

The doctor who had prescribed was a colleague and friend who I knew to be very diligent. I called her to learn more about the situation and she was just as shocked. She had taken her time to explain everything about the medicine (especially the risk of overdose), knowing that this was one drug the patient would need for the rest of her life. She even expected the patient to come for follow-up after the six weeks to check on her progress and see if there were any adverse effects.

It emerged that the patient had received contradicting information at the chemist which led to the overdose and the life-threatening outcome that I now had to deal with. It wasn’t an easy battle. Several organs had been affected and the balance of blood cells had been completely destabilized. Drug toxicities are notoriously difficult to treat. Many medicines we use do not have antidotes which can be administered to counter the effects of overdose. That was the case here. We used different strategies to get her system back to normal but she continued to deteriorate. After a number of days, she collapsed and remained on life support in the ICU for several days. Afterwards, she remained on treatment and close monitoring for months before her condition improved enough for her to resume some semblance of normal life. All this time, the treatment for her chronic condition, the one which caused her first admission, had to be suspended. It resumption presented serious challenges in the choice of medicines.

There must be many other cases which go unreported. In an environment where self-medication is so rampant, it is possible that even deaths attributed to other causes are caused by careless drug use. For a nation with such a liberal market of medicines one must assume the worst. A great deal of medical training is dedicated to understanding medicines. One cannot become a doctor without fully understanding the benefits and dangers of medicines. Only through this rigorous training can medical schools ensure that they are releasing to the society a doctor who is safe. Only such a person can be granted the power to prescribe medicines.

Yet we find that in Kenya’s permisive culture of handling medicinal product, the chemist takes the duo role of prescribing and dispensing drugs. During my spying at the chemist, I was amazed that a person goes to the counter, explains their problems and gets the medicine all in a span of few minutes. The entire diagnostic process that a doctor undertakes to determine the right treatment is by-passed. The role of the doctor is taken up by other people. We cannot be sure whether they are qualified pharmacists or pharmaceutical technologists. Even if they were, they cannot dispense medicines without prescriptions.

What is especially troubling is that this happens even for children’s medicines. The immature biology of the child is especially vulnerable to the effects of drugs. They must be carefully prescribed taking into account the weight of the child and other important factors. Most importantly, childhood is the time when exposure to infections is highest. This means than misuse of medicines predisposes them especially to developing resistance to antibiotics. There are many cases in children’s wards where by the time the child meets the doctor, they have been given various types of antibiotics from the chemist. Either the wrong medicine or incorrect dosing means that the doctor has to resort to injectable drugs because oral antibiotics are no longer effective.

Why does all this happen? One reason is simply lack of awareness on the dangers of medicinal products. Concerted efforts are needed to educate the population as a way of getting rid of this culture. But even if this was done, the high cost of hospital visits might still push many do skip due process and head for the chemists. Another major reason is the inefficiency of public hospital where long queues dissuade people from visiting hospitals. Those who do (those already queuing!) almost always find the hospital pharmacy empty. They have to go to the chemist to fill their prescriptions. A big risk here is that like my patient above, the patient goes whom confused between what they heard from the doctor (which they may have forgotten while in the long queues) and what they were told at the chemist.

So why do these chemists make mistakes? The question should be why they are allowed to operate in such a permissive environment. Chemists are supposed to operate under strict regulation. The fact that so many of them exist in our towns and villages means that the regulatory system is rather liberal. What is supposed to be a contribution to the broader health care system then becomes merely a profit venture. Since profits are the focus, no one cares about prescriptions even if they are required on paper to never issue drugs without prescriptions. If rules were seriously enforced, no chemist would agree to dispense medicines without prescriptions. That they are able to get away with unaccounted stock reflects the laxity of the regulatory authority. That they cause so much suffering is itself an indictment to whoever is responsible for enforcing regulations.

The best way to deal with the culture of self-medication is through adherence to international and national regulations of drug use. Most people take medicines they don’t need, often at dosages that are either low or high. The fact that ours is a nation of drugs is very clear from the many thriving chemists all over the place. It is one business that doesn’t seem to slow. Since this is a multifaceted problem, every one of us needs to be involved in remedying it. The public must be fully sensitized. Hospitals pharmacies should be properly stocked and managed by qualified personnel. The law must also set serious penalties for improper operation of chemists. In fact, the very establishment of chemists need to be regulated as it ought to and not treated as if it is an ordinary business.

He has led a remarkable campaign, defying the traditional mainstream parties courtesy of his En Marche! movement. For many, however, the campaign has become less about backing Macron and instead about voting against Le Pen, the National Front candidate.

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He has led a remarkable campaign, defying the traditional mainstream parties courtesy of his En Marche! movement. For many, however, the campaign has become less about backing Macron and instead about voting against Le Pen, the National Front candidate.

Capitalize on low hanging fruit to identify a ballpark value added activity to beta test. Override the digital divide with additional clickthroughs from DevOps. Nanotechnology immersion along the information highway will close the loop on focusing solely on.

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“To live by medicine is to live horribly”

Carolus Linnaeus

Le Pen has spent the past few weeks battling to extend her appeal beyond her traditional base of supporters, while Macron has been attempting to convince voters that he is not part of the political elite they rejected in the first round.

The Conclusion

The country is still under a state of emergency following those attacks and several others. Some 12,000 extra police and soldiers are on duty in the capital for election day to secure polling stations and the candidates’ headquarters, Paris police said.

Capitalize on low hanging fruit to identify a ballpark value added activity to beta test. Override the digital divide with additional clickthroughs from DevOps. Nanotechnology immersion along the information highway will close the loop on focusing solely on the bottom line.

 Kara Fox and Barbara Arvanitidis reported from Paris and Bryony Jones reported from Bordeaux. James Masters and Angela Dewan wrote from London. Sebastian Shukla and Karen Smith contributed to this report.

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1 Comment

  1. tiiraperspective September 6, 2019

    Sad

    Reply

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