Samuel Harry has been in coma for two days now. His family members are jittery and worried about his situation. The 43-year-old fashion designer had fallen sick on September 21 and visited a local drugstore to buy medicines. He had a cluster headache and felt that a typical local drugstore in the sprawling Lagos city would be able to handle the situation.
A manager at a drugstore prescribed Paracetamol and a combination of three antimalarial drugs. Harry took these drugs for 10 days without any improvement. Health experts often warn that once antimalarial drugs are taken for three days without any meaningful impact, the patient should see a doctor. But this warning was ignored. The doctor handling his case suggests that the fashion designer might have had a high blood pressure, which could easily have been managed by an accredited hospital and doctor.
When Harry went into coma, the doctor found that the medicines he had been administered with had no National Agency for Food and Drug Administration and Control (NAFDAC) number and expiry date.
In Nigeria, drugs produced locally or imported from other countries often pass through a regulatory agency known as NAFDAC, whose responsibility it is to examine whether they are fit for human consumption or not. But in the case of Harry, the medicines he took had no NAFDAC approval and there was no expiry date on the label. The doctor handling his case agrees that Harry also had malaria, but admits that the drugs he took were substandard.
So, apart from being administered with substandard medicines, Harry also visited a quack.
Harry’s case mirrors two of the biggest challenges faced by the Nigeria’s health system: quackery and influx of fake/ substandard medicines.
Quackery is redefining the Nigerian health profession today for the worse, as sick citizens find succour in the arms of quacks. One of the major drivers of quackery is poverty, as findings show that those who patronise quacks in the country are mainly in the lower rung of the ladder.
The National Bureau of Statistics estimates show that poverty rate in Nigeria is now over 65 percent as the country remains in the league of poverty capitals of the world, where you also find India.
“A man who cannot feed himself and family will never be able to afford hospital bills,” says Emeka Uzuegum, a health professional in Lagos.
“Hospitals are not free here. You need to go to hospitals with your automated teller machines (debit cards) because you don’t know how much you will be charged. So, at a minimum wage of N18, 000 ($59), how will the poor man afford a hospital, which may even charge triple of that amount for typhoid fever,” Uzuegum laments.
In June, the police in Nigeria’s capital— Abuja— arrested a suspected quack doctor, Victor Akpan, in the Gwarinpa area of Abuja.
Akpan had been running a private hospital for 10 years, allegedly operated with forged and stolen certificates.
He was said to have performed caesarean sections, removed fibroids and delivered pregnant women of babies.
One year earlier, the police had also arrested a senior medical officer working at the Federal Ministry of Health, Martins Ugwu, for practising as a medical doctor with stolen certificates for nine years.
“You can imagine what could have happened to their patients,” a medical doctor, Lillian Jackson, says.
“It is just that we do not care to know why people die here,” Jackson states.
But quackery is not limited to untrained people in the medical profession, but also extends to medical school graduates who are poorly trained.
A story was told in 2012 of a medical doctor who treated a patient in Bayelsa State while looking at his textbooks. The patient did not die, but developed complications.
“Yes, we have a problem with the quality of doctors we have here. But mind you, Nigerian doctors are the best abroad but the worst at home. This shows you that there is a fundamental problem with infrastructure and the condition under which they work,” she adds.
Away from quackery, drug quality remains a key issue. Nigeria is dealing with two major drug quality crises: counterfeiting and sub-standardisation.
A 2010 report done by US National Library of Medicine National Institutes of Health said that substandard products arose as a result of lack of expertise, poor manufacturing practices, or insufficient infrastructure, whereas counterfeits were the ‘products’ of criminals.
It further said that counterfeits might contain no active ingredient, incorrect ingredients, or toxins, though the amount of active ingredient would not provide sufficient information to accurately determine if a medicine was counterfeit.
It warned that globalisation of the pharmaceutical industry had the potential to rapidly spread poor-quality medicines worldwide before adequate detection and intervention were possible. This is the big issue in Nigeria.
The country is battling with counterfeits and substandard medicines.
A report released in February 2015 by NOIPolls revealed that 18 percent of Nigerians had personally been victims of fake, counterfeit and substandard pharmaceutical products, medicines and drugs.
Independent drugstores (68 percent) and drug hawkers (14 percent) were identified as the two main points of purchase of fake drugs/medicines in Nigeria.
One-thirds (35 percent) of the respondents who had been victims were only able to identify that the drugs were fake when there was ‘no improvement in health at the completion of dosage’, followed by 29 percent who cited ‘adverse reaction’.
The majority of the counterfeit and substandard drugs are smuggled into Nigeria through Cotonou, Benin Republic borders, findings show.
The medicines are cheaper than those produced locally and citizens prefer them to locally produced ones, says Chizu Agunwa, a medical doctor.
But not all medicines coming into the country are smuggled, as some are equally imported legally. Health experts, nevertheless, believe that more medicines are smuggled into Nigeria than legally imported.
However, counterfeit drugs are also produced locally.
In April this year, NAFDAC in Cross River State arrested a suspected counterfeit drug maker, Ernest Chubuike, who had been on the agency’s wanted list.
In May, a 35-year-old fake drugs manufacturer, Osita Eli, was arrested and jailed for five years without option of fine by a Federal High Court in Asaba, Delta State.
A number of criminal drug factories have also been identified and shut down, prompting experts to call for a stronger sentence of dealers and makers of fake, substandard and counterfeit drugs.
“Go the way of China. Hang them and forget about them,” an obviously angry Jideofor Ogbonna, medical officer at a private hospital, suggests.
But Ife Azih, biochemist and medical laboratory scientist, disagrees.
“Longer jail term, maybe life sentence or 20 years will do. Intelligence gathering is also key,” Azih added.
Similarly, professional bodies such as the Nigerian Medical Association and the Pharmaceutical Society of Nigeria, among others, have been asked to be more proactive to get more quacks arrested and prosecuted.
“We need to do more. How can someone practise for years without his purported professional group not knowing? It is these professional associations that should alert security agencies,” Ogbonna added.
Counterfeit and substandard medicines are taking a big toll on local drug makers who say they do not sell their products as much as they should.
Local pharmaceutical firms say the situation is dire as it is hitting hard on their margins and investments.
“The lack of demand for locally manufactured medicines as a result of cheap imports will lead to idle capacity and will negatively impact previous investments in the sector, worth over N300 billion,” Okey Akpa, chairman, Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN).
ODINAKA ANUDU
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