In the year 2001 or thereabout, I was a member of a delegation of
the Nigerian American Chamber of Commerce (NACC) that visited President
Olusegun Obasanjo at Aso Rock. The delegation was led by the President of the
chamber at that time, Chief (Mrs) Priscillia Kuye (SAN). When Kuye finished
addressing the President, she graciously requested if I had something to add.
I
rose up to grab the opportunity. But before I would speak, she introduced me to
the President as a pharmacist and chairman/ CEO of Neimeth International
Pharmaceuticals Plc, a successor company of Pfizer Products Plc. As I tried to
open my mouth, the President charged at me, “You pharmacists, you are the ones
that import fake drugs into the country!” I was stunned, but quickly
remonstrated that his statement was untrue.When he insisted, I told him emphatically that no trained and licensed pharmacist will deal in fake, adulterated or counterfeit drugs, except if he was insane (mentally deranged) or did so unknowingly. I told him that there were many interlopers and business miscreants who were pretending to be “pharmacists,” who actually were the ones making merchandise out of the suffering and death of innocent Nigerians. To further push his point as we all know that OBJ will never voluntarily lose an argument, he raised another accusation against pharmacists.
He said: ‘‘But some
of you make copies of your certificates and licences and place them in many
shops without adequate supervision.” Here I conceded that such could have
happened in the years of yore, when there were very few licensed pharmacists in
the country. I assured him that with the new Pharmacists Council decree of
1992, such practices had stopped and that as a matter of fact, there were many
unemployed pharmacists looking for jobs, so it would be unacceptable to the
profession and council for one person to oversee more than one premises or
outlet while others were without job.
We concluded this altercation which was now
beginning to make Kuye ‘uncomfortable’ by the question OBJ asked me. “Ok, you
have defended your people well, what should we do to stop or minimize the
problem of fake drugs?” I answered swiftly: Put the round peg in a round hole.
After the meeting, I was asked to stay back. I was given paper to write out my
thoughts and proposal. Few months later, late Dr. Dora Akunyili was appointed
as the Director General of the National Agency for Foods and Drugs
Administration and Control (NAFDAC).
I do not in any way take credit for her
appointment but for once Nigerians saw how a professional pharmacist put her
life on the line to battle the fake drug merchants and the great success she
accomplished for Nigeria
and Nigerian medicine consumers. We also noted what happened when a non
professional pharmacist was appointed to succeed her. Some of the achievements
were rolled back, because no other professional has the in-depth knowledge on
drug matters including the drug trade as the pharmacist.
After this encounter I began to reflect on why OBJ should place the problem of
fake drugs importation and distribution on the lap of pharmacists. Pharmacists
are the only professional group that are licensed by the government ‘‘to
manufacture, mix, produce, warehouse, import, export, distribute and dispense,
poisons and drugs” in Nigeria .
In short they are the custodians of drugs and poisons in Nigeria .
Poisons? Yes poisons- chemicals and concoctions that can kill.
Which is really the main reason government
assigned this weighty responsibility to a group of people who are thoroughly
trained and disciplined to manage these items called drugs or medicines. The
real truth is that most drugs and medicines are potentially poisons. That is to
say that they can really main or kill those who take them. That is the major
reason the profession of pharmacy was created to be custodians of drugs and
medicines, first to limit access to these potential poisons, and secondly to
ensure that those who need the drugs or medicines are sufficiently counselled and
guided as to how to take the medicines, when to take the medicines, what
quantity to take at a time and for how long, what to avoid when taking
particular medicines and how to respond should unanticipated reactions occur or
should an overdose be mistakenly taken.
The pharmacist is expected to be the
intermediary between the medicine (prescribed by a doctor or purchased over the
counter) and the patient. The truth is that anytime this intermediation is
breached, the patient or consumer of the medicine is actually putting his life
in danger, because the same drug that can heal when taken appropriately as
prescribed and dispensed may kill when taken inappropriately. And the tragedy
is that very many Nigerians have more or less committed suicide through taking
medicines inappropriately, often without the intermediation of the professional
pharmacist.
Therefore, from OBJ’s point of view, if
pharmacists are the only ones licensed to produce or import drugs, we should
not search far for whom to blame when we encounter fake drugs in the system.
Indeed this was the same thinking of our distributor in Lagos in the 80s. We had gone to Richson
Pharmaceutical Company to show him that a set of Pfizer pharmaceutical products
which he sold to a retailer in Ikeja were fake drugs. Richson laughed at us and
asserted: ‘‘Sam, I do not manufacture, I do not import Pfizer products, all
that I sell are gotten from you. So if you say these items are fake or
substandard, then it must be that Pfizer now produces fake drugs.” Of course, I
assured him that there was no way, Pfizer could manufacture fake drugs.
To cut a very long story short, we eventually
found out how the fake drug importers infiltrated his system by coming to his
boys in his absence to claim that they had bought products from us on credit
and were finding it difficult to pay and that Pfizer was putting a lot of
pressure on them to pay or face legal action. They claimed to have decided to
discount the products by 50 per cent, so that they could quickly raise cash to
stave off the legal action. Richson’s staff saw a good opportunity to make “a
kill” and inadvertently procured the fake drugs and mixed them with the genuine
ones they had brought properly from Pfizer in Nigeria . Ordinarily, this thinking
should be seen as reasonable and logical. But in our country many unreasonable
and illogical things happen.
The painful truth is that over many years, the
pharmaceutical professional space has been invaded by all manner of people who
see drugs just as items of commerce or mere medical disposables and in some way
the government’s acts of omission or commission have intended to undermine the
custodian status of pharmacists. It is not unusual these days to find decisions
about drugs and medicines taken without the input of pharmacists. In many
clinics, drugs are dispensed without the intermediation of a pharmacist. Even
in some government general hospitals, drugs are dispensed without any
pharmacist’s oversight. In several primary health centres in Nigeria , drugs
are procured and dispensed to patients without any pharmacist’s input. Here
there seems to be the misinformed and simplistic view that all that pharmacists
do is to ask patients to “ take two tablets three times a day” and as such any
‘idiot’ who can speak English can do the same. This misinformation surprisingly
gets hearing even in some high government quarters, peddled by agents who
profit from the suffering of Nigerian medicine consumers.
In the community, many private consumers of drugs can get any drug- ethical or
OTC ( prescribed or not) from roadside kiosks, moving intra and intra-city
buses and trains, open market stalls and even in bars, lounges and nightclubs.
This does not happen in most nations of the world including our African
neighbours. So why must Nigeria
be allowed to continue to operate in this way?
The result we face today is the growing
incidence of drug misuse and abuse. Recently the nation was embarrassed by the
international Codeine scandal and there is so much misuse and abuse with
varying morbidities and mortalities, most unreported. So like the fake drug
issue, who is to blame for the high incidence? The answers will be as varied
depending on who you ask, sometimes with disproportionate blame on the victims.
For me, the official and legal custodians of drugs- Pharmacists, their
professional associations and their regulatory agencies – Pharmacists Council
of Nigeria (PCN) and the NAFDAC can not absolve themselves. Yes, when asked,
they blame delay in signing the amended PCN act into law, and other lacuna in
drug control legislation, poor resourcing and funding of the regulatory
agencies, discriminatory and poor remuneration, lack of executive political
will and support for effective ring-fencing of the pharmaceutical space to
admit only those qualified and licensed to legally operate, following orderly
guideline.
My take is that these problems are not
insurmountable. I believe the call is for a new approach to ensuring that
professional pharmacists take full responsibility as custodians of medicines in
Nigeria ,
ensuring only responsible access to bring down the current level of damage
caused by unbridled access and consequent misuse and abuse. I believe that the
support of the governments of Nigeria
and other healthcare professionals should be taken as granted.
*Mazi Ohuabunwa OFR, FPSN.
*Mazi Ohuabunwa OFR, FPSN.
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