*The deadly game of medical quackery: How fake pharmacies are killing Nigerians (II)*

By Fatima DAMAGUM

Madam comfort was rushed into the emergency room by relatives. She was vomiting blood. Her mouth, blouse and wrapper were all stained with gruesome streaks of bright red blood. Her husband was alarmed, his eyes looking around in horror, while her children’s screams filled the emergency room.

Her pulse was weak and thready as she had lost a lot of blood. Despite the usual Nigerian bureaucracy and lackadaisical attitude to emergencies, I would like to think the doctors and nurses did their best for her. Unfortunately, she passed away on the table. It was a perforated ulcer.

Her family was inconsolable. Her eldest son said she frequently complained of chest pain, which they assumed was due to ‘ulcer’. She also had severe knee pain and was forever on pain killers. Emeka, who sold medicines in the market close to Madam Comfort’s shop, supplied her medication.

Oya, let us see the medicines. It was a mighty handbag full of all manner of NSAIDs: Diclofenac, Ibuprofen, Aceclofenac, Naproxen and Aspirin, all at very high and different doses. That was the first time I saw 200mg of Diclofenac in a single dose. And the poor woman was taking it three times a day.

The medicines exacerbated her gastric ulcer, caused it to rupture and bleed to death.

Who is Emeka? And what are his qualifications? He is a nursing school dropout in Abakaliki who came to the North to open his ‘shop’.

Every time I come across or hear of these situations, I ask myself: How did we get here?

Quackery in the pharmacy sector takes various forms. We have unlicensed pharmacies who operate outside the legal framework, dispensing medications without regulation or oversight – Metformin instead of Mefenamic acid, Misoprostol for abortion etc. Then they are individuals posing as qualified professionals, often with forged credentials, who prescribe and dispense medications they don’t understand. And of course, the widespread, unregulated sale of antibiotics, which contributes to the growing problem of antibiotic resistance.

Additionally, there is the sale of counterfeit drugs often manufactured in unsanitary conditions, containing incorrect dosages or harmful ingredients.

As if these were not enough, we now have a new trend: promotion of “miracle cures.” These are often unproven remedies marketed with false promises that can delay or interfere with proper medical treatment. Here, religiosity reigns supreme. Pastors and Islamic clerics are the masterminds behind these ‘cures.’ But that is a story for another day.

Several factors have contributed to the rise of medical quackery in Nigeria; the first of which is always, lack of access to proper health care. Many Nigerians, especially those in rural areas, do not have access to hospitals or qualified pharmacists. Patent medicine stores therefore become their only option. One half-baked quack will open shop in the village and become their alpha and omega. He will be calling himself ‘doctor’ while prescribing and dispensing utter rubbish.

Another major factor is our weak regulatory framework. Despite efforts by the Pharmacists Council of Nigeria (PCN) and the National Agency for Food and Drug Administration and Control (NAFDAC), enforcement of drug regulation remains weak. Corruption has eaten deep into this sector of the economy that it seems herculean to regulate. Bribery and corruption allow unqualified individuals to operate with impunity.

I know we try to blame everything on the economy, but in this case, it is really a factor.  The cost of seeing a doctor is beyond the reach of many, making self-medication or consultation with a quack an attractive alternative.

Then, of course there is the almighty duo of illiteracy and ignorance. Many people do not know the difference between a trained pharmacist and a shopkeeper selling drugs. They trust these stores blindly. Even the educated ones among us fall prey to this. How many times have you bought medication and compared it to what was actually written on the prescription? If the doctor writes levofloxacin, why then should levonorgestrel be given to you? If you have any confusion or question, ask!

The pharmacist or pharmacy technician dispensing the medication should be able to demonstaate the difference between pharmaceutical and generic names and why the names differ. Anyone with an ounce of training should be able to explain the prescription to you and how it matches the one he or she is dispensing.

The consequences of this quackery are devastating. Patients suffer from adverse drug reactions, delayed diagnoses, and even death. The public’s trust in the health care system is eroded and the fight against infectious diseases is hampered.

What can we do about it? The war against medical quackery cannot be won overnight, but several measures can help curb this menace and safeguard public health.

Regulatory agencies, such as the PCN and NAFDAC must intensify their crackdown on unlicensed medicine vendors and counterfeit drug manufacturers. This can be achieved through regular inspections, undercover operations and harsher penalties for offenders. Strengthening surveillance mechanisms and collaboration with law enforcement agencies will also help dismantle illegal drug distribution networks. Additionally, digital tracking systems, such as QR code verification for registered medications should be widely implemented to help consumers verify the authenticity of pharmaceutical products.

The Nigerian government already has all these checks and balances in place; the problem is, and has always been implementation. Everyday we see videos of crack down on drug dealers and illegal drug industries, but what has been done to them?

One of the main reasons people resort to unqualified drug vendors is the lack of accessible and affordable health care facilities in rural areas. Establishing more primary health care centres in rural communities will provide legitimate alternatives to quack medicine vendors. These centres should be well-equipped with trained personnel, essential medicines and diagnostic tools. Furthermore, mobile clinics and telemedicine services can help improve accessibility to care.

Sometimes, when things get overwhelming, I feel like I have no more fight left in me. But then, we hear of the daughter who has lost her hearing because of wrong dosing of gentamycin in childhood, or the father who died of an insulin overdose, or the mother who is comatose because of substandard antihypertensives and our resolve is renewed.

We will continue to lend our strength and voices (no matter the decibel) to the fight against quackery in the health sector.

May the soul of Prof Dora Akunyili rest in peace. Ameen.