It is a twisted reality: In The Gambia, you have to “hide” from authorities when trying to get your foreign currency exchanged for Gambian dalasi by street foreign currency dealers, but you are perfectly fine to walk around and buy medicine freely from any Cherno, Omar and Samba. Where do our priorities lie?
While waiting to join a vehicle for a trip to Basse during my recent visit to The Gambia, I heard a street vendor yelling “Garabee San”. (“Garabee San” is Wolof for medicine for stomach worms.) Out of curiosity, I asked to see the drugs he was selling. Upon examining the package of the drug, I was shocked by what I saw written on it. It read: “MADE IN INDIA FOR EXPORT ONLY”. I just could not believe my eyes. I reread it and asked permission from the vendor to take a picture of it (see below). Of course, I had a little back-and-forth conversation with this vendor, who, by all indications, appeared to have had little or no formal education much more any medical training. He said to me, “If you see this medicine is brought into the country by Kairaba Pharmacy, it means it is good for consumption.” I did not confirm that the drug was distributed by Kairaba Pharmacy.
How can we allow the importation or selling of such products in our country? India, a developing country like The Gambia, is manufacturing drugs that they don’t want their citizens to consume but will sell those drugs to us. It is obvious that the product is either ineffective or has chemicals that are detrimental to one’s health. Don’t we have people in our health institutions responsible for safeguarding us from such probable harmful products?
Another issue that needs to be addressed in our healthcare system is the establishment of drug stores by people who are not medically trained. The so-called pharmacy license embargo in The Gambia is doing nothing but denying people with the knowledge and skills to establish genuine drug stores. I would say the policy has encouraged more people to illegally open drug-store outlets, selling medications that could pose a threat to our health. The number of drug stores operated by medical illiterates in The Gambia is dangerously high and this needs to be looked at.
Having medications dispensed by people who are not trained to do so could lead to a host of health problems such as drug resistance and poisoning, complications arising out of the bad combination of drugs. Drug resistance could emanate from giving the wrong antibiotics to treat certain ailments. Giving inadequate treatment could also lead to drug resistance. A good example of that is Chloroquin for the treatment of malaria.
In The Gambia, patients can be inadequately treated for malaria by untrained personnel and that can lead to the ineffectiveness of the medication in treating malaria. People can also get reaction to drugs if what they are taking does not match well with other drugs being concurrently consumed. Allergic reactions could be systematic which is fatal and can lead to premature deaths. Systematic allergic reactions can lead to the inflammation (swelling) of the airways eventually causing respiratory failure or arrest. Dispensing medication to a patient without proper history-taking or having a background in pharmacodynamics (the understanding of the biochemical and physiological effects of drugs and the mechanism of their actions) poses immense risks to the health of the individual. For example, patients allergic to sea foods or eggs cannot take certain drugs. Most, if not all, medications have some side effects. Most drugs are metabolized in the liver and excreted by the kidneys. Giving certain drugs to patients with abnormal kidney functions could result in shutting down their kidneys. Drug toxicity is not uncommon when one is given medication that is beyond the daily dosage limit.
All the aforementioned issues are reasons to not allow people who are not adequately trained to diagnose, and sell drugs to, patients.
Not to point fingers or to apportion blame for the systematic problems we are facing in our society, but it is sad to say, notwithstanding, that our own people are sometimes responsible for creating the breeding grounds for the high levels of corruption and malpractices in the management of health care in The Gambia. I heard a story about a new public health graduate who was sent to Basse on postings. This guy arrived in Basse determined to change the way things were. He cracked down on the illegal establishment of drug stores. He went after grocery stores which were selling medications without a permit. His good intention was halted after he went after a prominent businessman (name withheld) who has no formal pharmacological training to sell medications in his minimarket. The businessman organized a group of Basse elders to urge, or if you like, compel, the public health officer to stop his crackdown. He was told: “Here in Basse, if you take it easy with the people, you will have what you want.” Alas, this young talented public health officer was corrupted and shut down by the same community he was trying to help.
Gambian streets are saturated with fly-by-night pharmacists who do not have licenses to operate. Some of them use other people’s licenses to operate their drug stores. And many of these drug stores are not equipped with the equipment and materials needed to run a drug store. Medication’s effectiveness or potency can be altered by high temperature levels. Should drug stores not be required to have a stable and reliable source of electricity to power a refrigerator 24 hours a day, seven days a week, for certain types of medications? Some medications are required to be refrigerated at all times otherwise they become ineffective. It is equally important to keep medications in an optimal room temperature. I challenge folks to visit their local drug stores in The Gambia and take a count of how many have refrigerators, not to mention a working AC system, in them.
The following can be done to prevent the premature deaths of Gambians caused by medication errors and mitigate some of our healthcare challenges:
Ø Form a task force which will go after vendors selling drugs in streets and grocery stores without the required licenses.
Ø Close shops and fine people caught operating drug stores without a permit.
Ø Go after the real pharmacists who provide their permits to the untrained and the unfit to sell medications. Rescind their permits, give them hefty fines or even issue jail time for repeated offenses.
Ø Put together a regulatory body that will regulate all pharmacies operating in the country. Monitor the products they sell and make sure they hire well trained staff to work in the pharmacy. This body will carry out annual surveys on all drug stores and determine if they should be allowed to continue operating or not.
Ø Lift the so-called embargo on the opening of drug stores by issuing licenses to highly trained medical personnel. This will bring people out of the shadows which will enhance monitoring and minimize the illegal operation of drug stores. The embargo has done nothing but increase illegal opening of drug stores and has fattened the pockets of corrupt medical officers who are issuing pharmacy licenses to people through the back door.
Ø Develop some training for people who want to operate a pharmacy. The training should include, but not limited to, sensitising attendees about regulations in operating drug stores, medication administration training, etc. Make it mandatory to receive some form of in-service training before the renewal of any pharmacy license.
Ø Classify some drugs such as antibiotics, diabetes medications, anti-hypertensive, cardiac, etc., as prescription drugs only. Drug stores found dispensing prescription drugs without valid prescription should be prosecuted.
Ø Allocate all prescribers unique numbers that are traceable for accountability purposes.
Ø Make it illegal to give injections to patients without a formal nursing training.
With simple policies and steps like the ones mentioned above, we can effect a change and mitigate some of our medication errors and save lives. I urge every Gambian to desist from buying medications from ill-trained pharmacy operators. Medications can kill you faster than they can cure you if the five rights of drug administration are not followed. The five rights to be adhered to are: administer medication to the right patient; give the right drug; give the right dose; administer through the right route; and give it at the right time. And then document it all.
Bakary M Jallow, a registered nurse, holds a Bachelor of Science degree in Nursing from Angelo State University and a master’s degree in Public Health from Texas A & M University, Texas. He is currently an infection preventionist clinician with the John C Lincoln Hospitals Network in Phoenix, Arizona, USA.
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