P. WENZEL GEISSLER

Forty researchers representing different social and life sciences came together in Mbale, Uganda, in November 1998 to present their findings on the use of medicines in East African societies. The researchers, from Kenya, Tanzania, Uganda, the USA and various European countries, were attending a one-week workshop on “People and Medicines in East Africa”. Organized by the Makerere Institute of Social Research and the Danish Bilharziasis Laboratory, the workshop generated lively discussion on new interdisciplinary research questions and interventions to improve medicine use at community level.

Several studies underlined that self-and home-treatment of common ailments are widespread in urban and rural areas in East African countries. Potent pharmaceuticals, especially antimalarials, are generally available and not always used appropriately by the public. Researchers drew attention to informal, home-based traders, who together with pharmacies and shops have a central role in the distribution of pharmaceuticals. The key role of children was emphasised in studies from Kenya and Uganda, showing that school-age children had extensive knowledge of medicines. Children were involved in home-treatment, particularly for illnesses related to malaria, and in many cases bought and used pharmaceuticals independently from adults.

Debating complex issues

A central question of academic and applied interest that recurred throughout the workshop concerns the relationship between medical practice and medical knowledge. Several presentations challenged the assumption that changed knowledge automatically gives rise to improved practice. They emphasised that the use of medicines must be seen within the context of people’s daily lives. Any attempt to improve home-treatment must start out from a solid understanding of the social processes of illness and healing in specific local settings.

Participants discussed detailed studies on the social and cultural context of medicine use, which did situate people’s practice with medicines in daily life. They revealed the important influence of social relations - for example, within families and households - of religious beliefs and spiritual experience, and of historical changes for medicine use. A psychologically focused research study on the nature of medical knowledge in Kenya underlined that this was a form of “practical” knowledge. It was generated in concrete action, rather than abstract academic knowledge. The importance of practical learning about health was stressed by studies on health education in Uganda. Ethnomedical research showed that the relationship of “traditional” medicines and pharmaceuticals in people’s practice is an important influence on people’s use of medicines. Another study showed how government drug policy, by affecting the availability of certain drugs, can change people’s practices and consequently their perceptions of medicines.

Researchers at Mbale. The workshop fostered consensus on crucial areas for further research on medicines use (Photo: P.W. Geissler)

Lessons learned

The researchers presented different intervention initiatives to improve drug use. Some described their problems in trying to convince colleagues and authorities of the need to train shopkeepers and community members in pharmaceuticals’ use. Their difficulties underlined the importance of a thorough understanding of the specific social and political context for planning drug use interventions. They also highlighted the need to involve key actors and groups with an interest in medicine use in the early stages of planning an intervention. Research from Kenya has helped to overcome some of the problems and has trained shopkeepers in improved drug-selling practices. The trial results showed an improvement in sales in terms of choice of appropriate drug and appropriate dosage. This may encourage decision-makers and researchers in other areas to experiment with similarly innovative training methods.

Another suggestion to improve knowledge about medicines was school-based teaching on the correct use of essential drugs. Since children at school age “grow into” their attitude to pharmaceuticals’ use, there is a need to provide them and their teachers with adequate information. What kind of information and how this should be conveyed, remains a topic for further research, which is underway in Kenya and Uganda. The positive experiences with teachers as health educators in various East African studies presented at the workshop suggest that schools are very suitable also for interventions for improved drug use.

Moving ahead

The workshop revealed variations in perceptions of home treatment. Some researchers saw this as an important contribution to improved health; others emphasised the potential dangers. However, everybody acknowledged the urgent need for both concrete interventions and further research on the subject.

The participants’ open mindedness and willingness to interact closely meant that the workshop increased mutual understanding and fostered consensus on crucial areas for further research. These include: the relationship between medical practice and knowledge; medicine use as social process and long-term change; medicine use by children and young people; the relationships between traditional medicine and pharmaceuticals, and between public and private provision of health services; and the importance of open-ended “action research” as a complement to other forms of research.

The participants decided to update each other about their work through an Internet bulletin board, currently in preparation. Concrete collaborative links were established, and participants agreed to extend the research network created at Mbale further and beyond the confines of the research community.

The workshop showed that people’s use of medicines will continue to stimulate research questions across the disciplines, and that this is an area with the potential for interventions that make a difference to people’s lives.

For a report of the workshop and further information on the informal network, People and Medicines in East Africa, contact: Dr. P. Wenzel Geissler, People and Medicines in East Africa, Danish Bilharziasis Laboratory, Jægersborg Alle 1D, DK-2920 Charlottenlund, Denmark. Tel: + 45-77327732, fax: + 45-77327733, e-mail: wg@bilharziasis.dk (include “people and medicines” in the e-mail subject field).

Celebrating 50 years of pharmacy education in West Bengal

Pharmacists from all over India celebrated 50 years of pharmacy education in West Bengal, not with reminiscences of times past, but by looking ahead to the future of their profession in the next millenium.

In November 1998, some 12,000 pharmacists attended a symposium on rational use of drugs organized at the Institute of Pharmacy, Jalpaiguri, as part of a national symposium on pharmaceutical education and the pharmaceutical profession in the new millenium. The pharmacists represented many sectors: community and hospital pharmacy, industry, education, policy management and regulation. But all benefited from hearing the message - that all pharmacists can play a part in promoting the rational use of drugs.

As a result of the symposium, workshops on rational use will be held to update general practitioners, pharmacists, nurses, and other health workers. Participants resolved to urge education authorities to include the concept of rational use in medical and pharmacy curricula. They will also try to ensure that drug policies throughout India highlight the need for availability and affordability of essential drugs and stress the importance of rational prescribing.