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‘How fake drugs harmed our patients’

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Doctors do not manufacture drugs. They only prescribe drugs made by pharmacists. But, in doing their job, they have been victim of fake

Doctors do not manufacture drugs. They only prescribe drugs made by pharmacists. But, in doing their job, they have been victim of fake drugs. Lives have been lost and damaged, writes Assistant Editor LEKE SALAUDEEN

 

He tells the story with a smile on his face now. But it would have been different if providence had not set in. Dr Ifeanyi Azubuike of the Military Hospital, Ikoyi, Lagos had prescribed a drug for his father, who was asthmatic. 

Then one day, he was called that his father’s condition was getting worse. He said: “I had an emergency call that my dad was dying. So, I had to rush home and seeing him I requested for his medicines and was told he has been on Franol. We took him to the hospital immediately and the doctor on duty gave him Franol again and in less than four hours he was responding well to treatment and by the following day, he was discharged.”

He later discovered that the Franol his father was given before being taken to hospital was fake and “that drug was prescribed by me and if my dad had died while taking it, they would have said I killed him.”

Azubuike said: “So many doctors have earned a vote of no confidence for medical accidents which after careful examinations have been traced to poor quality drugs and doctors are also prone to being sold fake drugs as only those who manufacture these drugs can confidently identify the fake one by merely looking at the external features.”

If Azubuike was lucky with his dad, it was not so for Dr Jide Adesanya who continues to live with the scar left on his practice by fake drugs. A hypertensive patient was admitted into his hospital. He said: “We had her medical history. So, it was not difficult for us to know what was wrong with her. The woman was placed on Nifedipine and Propranalol. Both drugs were bought from the hospital’s pharmacy. She kept taking these drugs but wasn’t responding well. Her blood pressure kept rising with every dosage.

“We invited a consultant and as part of his prescription requested for Hiaza- a brand of Nifedipine sold only in the United States. Somehow, we got the drug here and by afternoon of that same day, her blood pressure came down. We were happy.”

 But it was not yet celebration time. Before she was given Hiaza, which helped to bring down her blood pressure, the high BP had caused her a brain damage. “We found out that the temporal lobe of the brain had been affected badly. She eventually died at 56 of brain damage six months after”.

Dr Bayo Adedigba, who works in a private clinic in Lagos, will never forget his experience with fake drugs. As he put it: “It was a nasty experience that nearly made me lose my job and put a dent on my 15-year career”.

“I was on night duty on January 15 this year, when a patient with excruciating stomach ache was rushed in. I abandoned the patient I was attending to in order to give her urgent treatment because her case was critical.

“She was examined and I prescribed some drugs for her. Among the drugs prescribed was a particular syrup. Since the drugs were not available in the hospital, I had to call on our drug supplier, who is a qualified pharmacist to come to our rescue because it was around 1a.m. Leaving her till day break would worsen her condition.

“I gave the husband a note to the pharmacist and asked my driver to take him down. Within 30 minutes, they came back with the drugs.”

The syrup was first administered on her. The first spoonful of the drug she took led to another problem. As she scooped the content into her mouth, her tongue and throat experienced a painful burning sensation, which left devastating effects on these vital organs. “The husband became restless and started raining abuses on me,” Dr Adedigba said. He even threatened to sue him if his wife died.

That same night, Adedigba said the woman was taken to a tertiary hospital where she was operated on and the syrup was flushed out of her system. She spent two months in the hospital.

“What came to my mind was that the drug had either been faked or made of substandard products. Laboratory analysis confirmed that the drug she took was faked; it contained some corrosive elements,” Adedigba added.

 A doctor at a clinic in Surulere, Lagos still feels bad each time he remembers a patient, Mrs Rita Okon, who came to report a minor cough. She started vomiting blood a day after she started administering a drug he prescribed. The hospital had run out of supply of the cough drug, so the husband got one from a nearby patent medicine store. She was transferred to a specialist hospital. Three major operations were performed on her before she finally died after six months on the hospital bed. However, laboratory analysis found that the cough syrup contained some corrosive elements. 

Foreign medical doctors too have experienced the havoc that fake or substandard drugs perpetrate on patients in this country. There was an incident at the University of Nigeria Teaching Hospital where foreign medical professionals from an international charity organisation visited Nigeria to perform operations on some children. In the course of performing the operations, they realised that that the drugs were not having the desired effects and they believed that they might be fake, so they had to suspend the operations and turn away other patients rather than risk lives. As a result, some children died.

However, the hospital never told the parents of the children what happened. The story blew up when the foreign medical professionals published what they knew and the National Agency for Food and Drug Administration Control (NAFDAC) went into action and tested the medicines at the hospital. Most of them were faked and their origin was traced to Onitsha market.

A survey conducted by the World Health Organisation found more than half the drugs on sale in Nigeria were fake or substandard. It was found that Nigerian hospitals were using contaminated drips, surgeons were using fake adrenalin to restart the heart and anaesthetists were using fake sub-strength muscle relaxant on patients in their operating theatres.

Nigeria is losing patients daily to fake drugs and this loss continues to erode the integrity of the nation’s health system and weakens the confidence of the average Nigerian in the capacity of Nigerian doctors.

Counterfeiters have been formidable foes and it does not seem that the war against fake drugs is being won.

 NAFDAC is sustaining the fight by carrying out raids, seizure of fake products, public bonfires, close down and reopen markets believed to be hubs of fake drugs.

These many analysts say are not sustainable models for dealing with the problems of fake drugs. The right legislation and policies, for instance, are not in place. Erstwhile Director General of NAFDAC, Prof. Dora Akunyili did acknowledge this anomaly when she said: “The war against counterfeit drugs, beverages and other food products in Nigeria is not backed by effective legislation that can ensure sustainable results and impact; as grievous as this crime is, which is even worse than armed robbery, the penalty is like a slap on the palm, the most ridiculous of which is a fine of N50,000. Any offender would gladly pay this fine and return to business next day.”

The president, Dr Omede Idris, said doctors are doing their best to keep to standards. In an interview with the News Agency of Nigeria (NAN), in Abuja on Monday, he said that although medical practice in Nigeria still had its challenges as in other developing countries, Nigerian doctors were doing well.

Idris said: “The basic things that are to be done are being done within the available manpower and working materials; that I can attest to.

“But the tendency is the belief that standards have not been maintained.

“Within the context of the Nigerian system, standards are being adhered to; Nigerian doctors are keeping to the expectations of their training and that of the council in charge of watching over them.’’

He said that the Medical and Dental Council of Nigeria (MDCN), had emphasised the need for Nigerians to report cases of medical negligence and misdiagnosis, adding that the council always followed such reports to the end.

Idris stressed the need for Nigerians to appreciate the efforts of medical practitioners in the country, because it was only when that was done that they would work effectively.

Dr Kayode Yemitan, acting Head of Department of Pharmacology, College of Medicine, Lagos State University has blamed the growing incidence of fake and substandard drugs on lack of effective legislation that will strengthen the National Agency for Food, Drug Administration Control (NAFDAC)

He said: “ NAFDAC still has a lot to do in order to achieve their set goals and objectives. They need to improve on their staff and expertise to counter the menace of fake and substandard drugs. Another thing is that NAFDAC should intensify on pre-shipment inspection. NAFDAC should go to where the drugs are being imported from and make sure that they supervise the production of the manufacturing companies before the drugs are imported to Nigeria. If NAFDAC has been part of production line, the problem of fake or substandard drugs will be reduced drastically. The locally produced drugs do not have too much problems because the regulatory bodies monitor their production except those who produce in unregistered locations.“

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