To show that:
Medicines are more than mere technical fixes;
As commodities, they are embedded in the political and social structure of the society;
As consumables, they assist to make sense of our health problems;
In the developing world, they constitute a public health problem.
The invention/discovery of medicines is perhaps one of the greatest achievements of humankind.
With medicines, humankind has been able to control and in some cases eradicate certain diseases which had plagued earlier generations.
This effort, together with improved sanitation has seen an increase in human life span especially from the beginning of the C20th;
Today, medicines constitute the core of allopathic medicine.
MAIN USES OF MEDICINES
To treat diseases (chemotherapy)
To prevent diseases (prophylaxis)
To control pain (analgesics)
However, due to human ingenuity, medicines are now used for situations other than the above. Thus, medicines represent good-bad news.
OTHER USES OF MEDICINES
People use medicines to increase or suppress appetite;
People use medicines to enhance sexual performance;
Sportsmen and women use medicines (steroids) to enhance their performance;
People use medicines to ‘tone’ or bleach their skin to enhance their beauty; etc.
THE CHEMICALIZED WORLD
According to Illich (1975), we are now experiencing ‘ chemicalization of life.’
We eat, drink, breath and even sleep in chemicals. And when we die, our bodies go through chemicalization (formalin).
Thus, health practitioners and the medical industry have become very powerful in modern society and dictating the minutiae of our lives and creating iatrogenic or new diseases.
As observed by Halfdan Mahler, the former Director-General of WHO (1978), the health industry has become a ‘sorcerer’s apprentice’ – the slave of our imagination has become the master of our creativity.
In short, human society has lost control over this industry, its technology and the modes of consumption of its products.
To appreciate the problems of drugs in the developing world, one must first gain some insight into the politics of the pharmaceutical industry.
In the developing world, the issue of pharmaceuticals may be likened to good-bad news.
The good news is that today
THE GOOD NEWS
Over the last decades, the drug industry has produced hundreds of new drugs that have effectively controlled most of the diseases that killed many people in the developing world: malaria; cholera; typhoid fever; tuberculosis; bilharzia; etc.
We may recall that in history, the West African region was known as the ‘Whiteman’s Grave’ due to endemic malaria and yellow fever.
THE GOOD NEWS
Today, mortality rates have reduced considerably because medicines are everywhere even in the remotest villages where there are no health facilities or personnel;
There is medicine for virtually every physical or non-physical condition (including depression, mood swings and nausea, menstrual disorders and even HIV/AIDS).
THE BAD NEWS
For most gvts of the developing world, one major problem is that they have no control over the production and distribution of pharmaceuticals in spite of the fact that these are very central to national stability and the health of their people.
Korn (1984) refers to pharmaceuticals as ‘political barometers’ in the developing world. Shortage of medicines can cause political instability (eg Ghana 1979).
During the colonial period colonies were made to depend on the colonial powers for a number of finished products. Today, long after colonial rule former colonies find themselves in the same trading relationship.
The result is that many developing nations find their markets still flooded with European goods including medicimes.
The pharmaceutical industry is dominated by very powerful multinationals.
For instance in 2010, 15 multinationals sold medicines worth $2,400 million which is far more than the GDP of most developing nations.
Given their financial power, multinational pharmaceutical coys are like sacred cows in the developing world.
THE BAD NEWS (2)
And in the developing world, they use their financial clout to influence health policies.
Through aggressive advertising, they rob people of their scarce resources and divert their minds from the insanitary environment.
Thus, the sicker the people, the bigger the profit margin of pharmaceutical coys.
It is in the interest of the developed world that the pharmaceutical market of the developing world should expand and that the health system should remain curative-oriented so that more medicines can be imported to enhance the profit margin of drug manufacturing companies.
Thus, today many developing countries spend a large part of their budget on medicines importation.
As Gould has observed: “The first thing to understand about the pharmaceutical industry is that it is big business. Its executives are not members of one of the pompously labelled ‘caring professions,’ nominally devoted to the alleviation of human suffering…They are trades people and trades people of a particularly hard-nose kind” (Gould, D. 1985. The Medical Mafia: 157).
An added problem of medicines in the developing world is the phenomenon of fake drugs.
In Africa, this phenomenon began around 1973 during the oil crisis when the lack of foreign exchange to import foreign commodities led to the emergence of all manner of fake products. In Ghana fake drugs still abound on the market.
In sum then, pharmaceutical coys contribute significantly to the problem of distribution and consumption of medicines in the developing world.
WHERE TO STOP THE BUCK?
To be fair, we cannot blame all the problems of pharmaceuticals on the coys. In a way, developing countries and their citizens have also contributed to the problem. Their contribution may be classified as macro (statist inertia) and micro (the role of culture, illiteracy etc)
MEDICINES AS COCACOLA
Bledsoe and Goubaud (1988) have observed that in Africa, medicines are as available as coca-cola;
They are sold by all manner of people – pharmacists as well as ordinary people; and they are sold everywhere – in market places and in the open.
Often, because of poor ambience, medicines become toxic before they are consumed.
THE AMBULANT VILLAGE ‘PHARMACIST’
It is instructive to note that many children in Africa die even when they are supposedly vaccinated. This is because often the break in the ‘cold chain’ renders many of these vaccines ineffective:
From the European manufacturer;
To the ship or aircraft that brings in the vaccines to the port;
To the local vehicles that transport them to the regional and district health centres;
Finally, to the community health nurses who carry these vaccines in icepack containers to the villages.
The tendency to break the cold chain is very, very high. Consequently, many children are vaccinated without any effect.
The question that may arise from these situation is: Where are the institutions to ensure that the right things are done?
Some of the institutions with oversight responsibility for the drugs market include the following:
Ministry of Health
Ghana Health Service
Ghana Standards Authority
Ghana Pharmaceutical Society
Ghana Medical Association
Ghana Association of Medical Representatives
Christian Health Association of Ghana
Ghana Pharmacy and Dental Council
Ghana Federation of Traditional Healers
Food and Drugs Board.
These institutions have direct or indirect
stake in the pharmaceutical sector. Yet their
roles are not fully felt because of lack of clarity in roles. As a consequence……
THE MICRO FORCES
While the inability of state institutions to exercise their oversight responsibility is a critical factor in the misuse of medicines, it is important also that we turn to the social and cultural beliefs and behaviour of the people.
ANTHROPOLOGY OF PHARMACEUTICALS
Until the early 1970s, anthropologists were not interested in medicines, regarding them as the domain of the health profession.
However, in 1976, Milton Silverman described how the developed countries were dumping sub-therapeutic medicines with wrong leaflets in Latin America (The drugging of the Americas)
ANTHROPOLOGY OF PHARMACEUTICALS (2)
In 1981 Diana Melrose wrote: The Great Health Robbery: Baby Milk and Medicines in Yemen
In 1982 she also wrote: Bitter Pills
In 1982, Silverman, Lee and Lydecker also wrote: Prescriptions for Death: The Drugging of the Third World.
All these were attempts to bring to the fore the problems of medicines in the developing world
THE SOCIO-CULTURAL CONTEXT OF MEDICINES
“I TAKE PARACETAMOL WHEN A MAN WANTS TO SLEEP WITH ME. IT WORKS LIKE A CONTRACEPTIVE.” (K. Senah 1997 Money Be Man Pp: 1).
Which drug manufacturing coy taught this girl to use paracetamol as contraceptive?
Which coy has instructed young girls in Ghana to use cytotec to effect abortion?
In Ghana, our inability to handle medicines effectively is also due to lack of pharmacists and to their unwillingness to operate in the rural areas
To address this problem, we have two types of medicines outlets – pharmacies and chemical shops. Pharmacies are to sell ethical/prescription medicines (class A&B) and over-the-counter medicines (OTCs);
Chemical shops are to sell OTCs only.
However, as is currently the case, due to lack of effective supervision by the Pharmacy Council, chemical shops sell Class A & B medicines also while pharmacies do not insist on prescription from clients.
In the villages, the operatives of chemical shops are called ‘Doctors.’ For this reason they must behave as such if they are to maintain their clientele.
THE CULTURAL ANGLE!
In Ghana, we distinguish between African medicine and European medicine. Often, the latter commands considerable respect (In distant lands lies faith!).
We also self-diagnose and prescribe medicines and determine how they should be used ( antibiotic capsules may be opened and their contents poured on open wounds, M&B and palm kernel oil for dressing circumcision, Tetracycline in palm wine to treat STIs, etc).
Medicines are shared with friends and relatives who may suffer from similar health conditions;
We define when we should stop taking medicines;
Where medicines should be taken with calibrated measures, we use other measures.
Where doctors’ prescriptions cannot be met, we purchase medicines in combinations that suit our ‘pocket budget.’
We believe that a doctor must prescribe medicines any time we report sick. And his expertise is judged by the number of medicines he prescribes for our health condition.
Medicines are critical in modern therapy management. As technical fixes, they need expert handling.
But in the developing world where climatic conditions are not favourable medicines become toxic before they are consumed.
In Ghana, as in many African countries where control measures are not strictly enforced consumers buy medicines just as they fancy
Our cultural beliefs and practices often pose danger to the use of medicines.
Medicines are therefore applied by wrong people, for the wrong conditions and in the wrong dosages.
It is in this regard that in the developing world, medicines are described as public health problems and also as ‘death for sale.’
FOOD FOR THOUGHT