(1998; 36 pages) [French] [Russian] [Spanish]
Letters to the Editor
Working for change in Ghana
By chance I recently came across a copy of your journal, the Essential Drugs Monitor, and although it was a 1993 issue it was very educative. Since completing my pharmacy studies in Ukraine and returning to Ghana I have found misuse of drugs (particularly antibiotics and sedatives) on a massive scale. I have come to the conclusion that irrational drug use is mainly due to the lack of effective sources of information for patients, pharmacists and doctors. At my community pharmacy I have tried in my own small way to educate people, but their insults and the potential loss of revenue for my business sometimes overwhelm me.
The Monitor gave me the idea of creating an effective, independent drug information service, where information will be given free of charge, or, when necessary, for a token fee. While I work on turning this idea into reality, I would appreciate it if you could continue to send me your journal and also help me to contact organizations that already have a drug information unit. We can then liaise and I can benefit from their experience to create a substantive, effective, independent information unit for my people.
- Justice Dogbey, Pharmacist,
P.O. Box KB516, Korle-Bu, Accra, Ghana.
Drug donations in Rwanda
Drug donations to developing countries have become a key factor of international humanitarian assistance in the field of health. People respond enthusiastically to each emergency appeal made by NGOs, out of a desire to help those most in need. Nevertheless, the well intentioned but misinformed individuals and institutions that wish to make their modest contribution can hardly imagine the harmful consequences that result from large-scale donations for the recipient countries. Lack of training in the management of essential drugs often means that part of the donations are useless.
In almost two years experience in Zaire and Rwanda, during the refugee crisis of 1994 - 1996, I witnessed the arrival of tons of drugs that nobody had requested. Many of them are still stored there - either they have expired or the local population does not know how to use them - pending a means of eliminating them without risk either to health or to the environment.
At the time, any form of assistance was welcome, but attempting to make use of the unclassified drugs arriving from Spain took away valuable time from an essential task: distributing drugs to pharmacies and health centres, and advising local workers on their correct use.
For more than three months, four of us, pharmacists responsible for managing drugs provided by Spanish assistance, had to spend on average four hours each day sorting out those that were suited to immediate needs. Those we threw away included drugs that had expired, others that were unsuited to the diseases prevalent in the area, others in amounts which were insufficient to treat a patient, many not included in WHO’s Model List of Essential Drugs and many others.
Despite all these drawbacks I must emphasise that many of the drugs were used and helped to treat thousands of patients, thereby saving considerable expenditure. Nevertheless it might have been preferable to load one of the humanitarian assistance aircraft sent from Spain with urgently needed drugs which had been purchased directly from specialist firms. Alternatively the drugs might have been sorted more systematically in Spain before they were sent, so that the work of the hundreds of volunteers taking part in the campaigns and of the pharmacists working in the field could be truly effective.
Since self sufficiency in drugs for all countries is a long way off, we have to be realistic and work in more than one direction at once. As donations will still be needed in the future, we should direct our efforts towards ensuring that 100% of the donations made are actually of use to the recipient. To this end society must be informed and educated.
Knowledge of the problems, of its causes and possible solutions, the realisation that the situation can be changed and a commitment to put change into practice is the main challenge facing health professionals in general and health cooperation NGOs in particular1.
1 For further information on improving drug donations see: Guidelines for Drug Donations. Geneva: World Health Organization; 1996. WHO/DAP/96.2.
- Natalia Herce,
Pharmacist and Medicus Mundi’s
Project Manager in Rukoma, Rwanda.
Indian survey reveals doctors’ misgivings on training in RUD
Criticism about the lack of input on rational therapeutics in India’s undergraduate medical curricula was voiced by a number of participants at a national consultative meeting on the rational use of drugs (RUD) held in Calcutta in 1995. Delegates called for an increased focus on needs-based clinical pharmacology teaching at undergraduate level, and for the gap between students’ knowledge about drugs and knowledge of their optimal use to be narrowed.
Concerns expressed at the Calcutta meeting prompted a survey of 2,200 junior doctors in India. This has shown that most received no information on the essential drugs concept during their training. Carried out by the Calcutta-based NGO, Foundation for Health Action, the pilot survey aimed to discover what recently qualified doctors thought about the adequacy of their undergraduate training in rational use of drugs. It also sought their opinion on the feasibility of initiating a compulsory refresher course on rational use towards the end of medical training.
A structured multiple-choice questionnaire was given to the doctors, who worked in various disciplines at seven training institutions in four regions of the country. Analysis of responses showed that most participants wanted standard therapeutic guidelines to be produced for commonly occurring ailments. Almost all were in favour of a compulsory refresher course on rational drug use for interns during the internship period. It is anticipated that such a course would be held for two hours weekly over four weeks, and run collaboratively by staff from departments of pharmacology and clinical medicine. The emphasis would be on causes and consequences of therapeutic failures, assessment of therapeutic outcomes, alternative drug therapy, adverse drug reaction monitoring, drug interactions, and risk-benefit and cost-effectiveness of drug therapy.
The study concludes that there is an undoubted need for reinforcement of knowledge. In particular it demonstrates a need for further inputs on prescribing guidelines in the later stages of the undergraduate curriculum.
- Krishnangshu Ray,
Assistant Professor of Pharmacology,
Department of Pharmacology, Calcutta
National Medical College, 32 Gorachand
Road, Calcutta-700014, India,
and Pijush Kant Sarkar,
Professor of Pharmacology and Director,
School of Tropical Medicine,