On January 21st, the British Council launched a $20,000 project to help ensure that the erroneous prescription of drugs as well as the overuse and misuse of medicine does not make the cure worse than the disease.
The Yemeni Society for the Rational Use of Drugs will hold two, two week courses at Sana'a and Aden Universities for internship medical students, financed by the council's small grants scheme.
'These students are mature enough to understand our message and flexible enough to change their style of prescription', project manager Dr Afrah Abdulaziz Al Zoba told The Yemen Times. 'Choosing experienced doctors for the course presents two problems: it is difficult to find them and they tend to be set in their ways'.
There are five main reasons for the widespread misuse of prescription drugs in Yemen:
(1) High illiteracy rates make it impossible for people to read the instructions, which come with the medicines. This means there is no awareness about expiry dates.
(2) Many drug companies offer financial incentives to doctors and pharmacists to promote certain drugs. Ethical standards can be compromised because doctors are poorly paid and those working in government hospitals have to supplement their meager incomes by opening private clinics at night time.
(3) Prescription happy teachers and professors in medical colleges pass on their habits to students who receive a lot of information about drugs but little training in rational prescription. There are many gaps in the doctors' knowledge as they often do not keep up to date with the latest information and developments about new medications.
(4) Scant implementation of the law dealing with the prescription of drugs.
(5) Self medication: people often buy drugs directly from the pharmacy without consulting the doctor.
'We are focusing on three main areas: knowledge, ethics and economics', Dr Al Zoba explained. 'After the first project for medical students we hope to implement another project for the older generation of doctors'.
The Yemeni Society for the Rational Use of Drugs launched an education programme for consumers and health workers aimed at ensuring that suitably priced drugs reach the needy members of the society.
'We tried to establish a community pharmacy, with the focus on education, at Sana'a University. The Dutch agreed to fund it and the university was supportive of the idea, but the Ministry of Health did not agree', Dr Al Zoba said.
In 1998, the society launched a Yemeni Drug Action Programme through a TV and radio campaign, posters and discussions in mosques, markets and gatherings of men and women, to promote the rational use of drugs.
The society pointed out that drugs are not a universal panacea. If someone is suffering from malnutrition they need to improve their diet and not fill themselves up with vitamins. An attempt was also made to dispel the myth that antibiotics can cure every illness.
'I worked as a pharmacist and I have seen the problems first hand', Dr Al Zoba emphasized. 'People come to the pharmacy and ask for half the dose because they can't afford what has been prescribed. Or they ask for the cheapest drugs'.
An information sheet concerning the UNDP's (United Nations Development Programme) GEF (Global Environmental Facility) activities on Socotra provides a penetrating flash of insight into the problems of the misuse of prescribed drugs.
In contrast to the practice of most government hospitals on mainland Yemen where some financial contribution is required from patients, medical services and drugs delivered by the hospital on Socotra are free of charge. This encourages misuse of medical services and drugs and leaves the medical system without any local budget.
When the drugs arrive, unnecessary and uncontrolled prescription and distribution habits usually deplete stocks in less than two weeks as the local population tries to get as many drugs as possible. Some people will even pretend to be sick to get drugs which will be stored and self prescribed according to the limited knowledge of the individual.
In rural areas foreigners are always asked for drugs and when drugs are available, people bring many of their children in order to get as much medicine as possible making rational prescription impossible. Injections are generally preferred to drugs taken orally even though they are cheaper and more effective. Infusions of dextrose and saline are often self administered even for minor illnesses. In popular thinking blood transfusions cure everything and they are certainly overused and would be done even more frequently if it were cheaper and more easily accessible.
There are 28 pharmacies on Socotra. They differ considerably in the number of drugs available and in the medical know-how of the owners who often prescribe drugs themselves.
Dr Al Zoba, no stranger to the intractable problems of Yemen's health services, admits that the society is battling against seemingly insurmountable odds. But it is better to light one candle than curse darkness.
'We are an NGO. We can't make laws, we can't improve the health services but we can exert some pressure and make some suggestions. Eighty doctors will be trained to prescribe drugs rationally. Imagine how many patients they will treat throughout their working lives'.

Mahfouth A Bamashmus
FRCSEd, FRCOphth
Consultant Ophthalmic Surgeon
Ibn-Al-Haitham Clinic
University of Science & Technology, Sana'a

There is disagreement about whether computer screens (VDUs) can cause damage to your eyes but we do know that environmental factors affect visual comfort and performance. This article is intended to help you to have a more pleasant and less fatiguing work environment.

Computer (VDU) users complain about their eyes about twice as often as other people at work. If you are about to start work with a VDU, you should have an eye examination. The optician can then see if there are any problems which could give you trouble and advise you how to avoid them.

Eyestrain:
Even though you can see clearly, it is still possible to have tired eyes. If your eyes are having to take in a large amount of detail over a long period of time, eyestrain is more likely.
Eyestrain is the term used to describe a wide range of problems including tiredness, irritation, soreness and sensitivity to light.

Computer (VDU) users are more prone to eyestrain than the average worker. The most common causes are: -
1.A fault in the focusing of the eye;
2.The eyes not working "as a team";
3.Incorrect positioning of documents;
4.Unsuitable lighting;
5.Poorly designed work areas;
6.Lack of adequate maintenance and poor placing of the VDU and keyboard.

All of which can be corrected by attention to the work environment and regular visits to an eye doctor.

CONTACT LENSES
Contact lenses are suitable for use with VDUs as they give less distortion and reflection than glasses. However, when first used with VDUs, problems may arise if the lenses start to dry. This problem usually disappears once the wearer has got used to the lenses. It is also important to blink normally and to keep contact lenses clean and free from scratches to achieve the best possible vision in all circumstances.
Older VDU users who have contact lenses for an existing eye problem may need additional reading glasses.

EYE CO-ORDINATION
Each eye is moved by six muscles; but if these, or the nerves controlling them, do not work properly, it makes it difficult for both eyes to work together. This may make your eyes tired and sore, and you may get headaches or blurred or double vision. It is a simple matter for your optician to find this during an eye examination.

EYE EXERCISES
After an eye examination, if your optician finds that your eyes do not work together properly, eye exercises can sometimes solve the problem. During treatment, you may have to spend a short time each day on the exercises. It might also be necessary to wear glasses.

MEDICAL HISTORY
If you have headaches, or marked discomfort from "flicker", or problems with VDUs, televisions or fluorescent lighting, you should be sure to mention this when you have your eyes examined.

WHICH SCREEN?
VDUs with "non-reflective" screens and clearer letters have improved working conditions for users. Unfortunately, models with highly reflective screens and poor letter definition are still marketed. You should not be able to see reflections when sitting infront of an unlit screen.
VDUs come in a variety of screen and character colors and increasingly, with multicolor displays. The legibility and suitability of the display are affected by the contrast between the screen and the characters as well as the general office lighting. It is not primarily a question of the colour. Brightness and contrast controls should be handy. Most VDU screens can be adjusted to suit your requirements.
Regular maintenance of VDUs is essential. The screen should be kept clean and any flicker or unwanted movement of the letters should be corrected as soon as possible.

POSITIONING OF EQUIPMENT
Incorrect siting of equipment may cause strain. Frequently, a VDU is positioned where a typewriter was originally, but good positioning for typing is often very poor for VDU work.
Keyboards need to be movable and should be positioned to ensure maximum comfort for the user. The position of documents should also be variable. The overall work range is normally between 33 Ð 100 cm. There should be sufficient space behind your VDU for you to be able to look past the screen so that your eyes can relax.

PSYCHOLOGICAL CONSIDERATIONS
Some tasks are tiring, because they are physically or mentally demanding or monotonous. Complains of eyestrain can be caused by psychological facts such as stress, repetition and lack of interest. Users should have a different task for short periods every hour or so to help reduce tiredness.
During training, mental concentration and unfamiliar visual tasks can be expected to cause eyestrain. Usually this doesn't last long. If it does, have your eyes examined!

Routine eye exam by an eye specialist is very important. It is your sight and your eyes need all the care they can get.

Reference: Eyecare information Service, London.