By; Dr. Louis Machogu
Somewhere in our make-up, there is a thread not too impressed with laws. If our friend’s mother runs a village pharmacy, licensing it is something we may agree is excessively onerous. We may find ourselves a little hostile to the Pharmacy and Poisons Board, ready to view our Mama Duka as overly persecuted and interfered with in her noble mission to serve us all with medicines.
Except for the small fact that our Mama’s store is filled with lethal drugs.
Give us the wrong dose and our second child may sustain kidney damage that never even shows until the day she dies at 32 years old, paying the final price for medicines provided by a quack.
In fact, one-in-ten Kenyans would rather consult a pharmacist than go to a hospital, according to the 2013 Kenya Household Health Expenditure Survey, and almost a third buy medication over the counter without a prescription: yet that opens the door to far more than incorrect dosing, if it turns out the pharmacist isn’t a pharmacist at all.
There are ways in which different medicines can be combined that can be deadly. Statins, for instance, are common drugs prescribed to lower cholesterol and reduce the chances of strokes and heart attacks. On their own these drugs are safe enough. But combine some of them with the antibiotic erythromycin, used commonly to treat chest infections, and if a patient is already taking certain statins, the result can be permanent liver damage – and another early death.
And are we all confident that Mama Duka knows that, and about all the other factors that drive safe medication? By contrast, pharmacists are doctors, which acts as an extra protection against misdiagnosis and incorrect prescriptions and medicines, and that matters too. For if you have typhoid but you think it is malaria and get an anti-malarial, you won’t get better, and you may well die.
Moreover, qualified pharmacists are taught to know what medications look like: they are far more able to spot fake drugs and stop them being sold to customers, which also matters when 274 Africans die every single day as a result of fake medicines, according to the World Health Organisation. As it is, an estimated 30 per cent of all medicines sold in Kenya are fake. Critically, many medicines for chronic diseases such as diabetes and hypertension are dispensed without the active ingredients in them that cure, treat or prevent diseases – making the patient’s condition worse.
Moreover, Mama can get those counterfeit medicines much more cheaply than the real deal active drugs: could she ever be tempted to get the cheaper lines, unregulated and unregistered?
Yet that’s a killing game, and if we all understood the risk she was taking with our children’s lives, very often accounting for death after local death, we might be a lot more offended by any unregistered pharmacy and a lot more supportive of the Pharmacy and Poisons Board in its challenging task of keeping up with the illicit chemists.
Indeed, since 2016, the Pharmacy and Poisons Board (PPB) together with the National Police Service, has launched wave after wave of countrywide crackdowns to close down unlicensed outlets. As a result, by 2018, 994 illegal pharmaceutical outlets had been closed down, with Nairobi topping the list with 105 outlets closed. Last year, alone, 110 pharmacies were closed down in Nyeri, Muranga Kiambu, Kirinyaga, Nyandarua , Embu, 71 in Mombasa, and 80 in Nairobi.
But getting rid of the quacks has become a contest – for every two illegal outlets that are shut down, four new ones surface.
The introduction of the PPB’s health safety code, 21031, that lists the registration details of legitimate pharmacists and their location has been a gamechanger in weeding out illegal chemists.
However, with only 5,840 pharmacies registered of an estimated 15,000 outlets, distinguishing legitimate pharmacies is still a challenge for consumers, which is where we are now promoting a new and further aide. Our aim is to raise public awareness in support of the PPB’s mission to eradicate unlicensed practitioners, and help consumers spot a registered pharmacist with all the necessary professional and regulatory qualifications.
To which end, we have launched the Green Cross symbol and signage as the mark of qualified pharmacists. The Green Cross has been used as a symbol of professional medical dispensaries globally. It’s our belief that even as the PPB works to close down our illegal pharmacies, saving thousands and thousands of lives, such signposting can assist consumers is choosing to buy medicines from pharmacy professionals rather than quacks.
Indeed, the Green Cross can serve to encourage investment into legitimate pharmacies too, drawing in pharmacists who are unemployed, rather than leaving quacks handling potentially dangerous medicines for the public. For, as the PPB succeeds in stamping out such abuses, the public still need access to pharmacies, raising new investment needs for legitimate pharmacies.
Thus, legitimate pharmacists can display the Green Cross as a guarantee that a pharmacy has a license, proper premise conditions, the required medical equipment, lock-and-key storage facilities for expired/restricted drugs, a semi-private patient counseling area, and qualified pharmacists and staff. For the Kenyan public need the critical information that can prevent them killing their own families with illegal drugs from illegal pharmacies.
Dr. Louis Machogu is the President, Pharmaceutical Society of Kenya