British Council Promotes Rational Use of Drugs [Archives:2001/05/Health]
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’.