The story of drug shortages rocking Malawi has become more than just a crisis paralysing the public health service delivery. It is also a tale of opportunism, intrigue, furtive glances and suspicion as vendors somehow access drugs meant for government hospitals and secretly sell them to desperate locals.
Nation on Sunday investigations in Blantyre, Balaka, Ntcheu, Mzuzu and Lilongwe reveal how the poor searching for medication at rural health centres are bearing the brunt of the situation as the drug black market thrives.
The investigations also expose the ingenuity vendors are using to evade the prying eyes of government and police to make a killing out of the crisis through the stolen government drugs.
In Mkutumula 1 Village, T/A Makwangwala in Ntcheu, there is a name that springs to everybody’s mind on issues of drugs. We will call him Drug Baron.
According to sources we interviewed in the village, Drug Baron is the key man who supplies drugs to people in the area, vendors, rural health centres and buyers from as far as Lilongwe.
He sells the drugs on both retail and wholesale basis on designated market days. On Mondays, he can be found at Pengapenga, whereas on Wednesdays, he sells the drugs at Banda in the area.
In pursuit of the drug trail, we went to Banda last Wednesday. Down on our luck, we found Drug Baron already done with the day’s business because of a downpour that came earlier in the day.
After arriving at the trading centre at around 4pm, we asked around for someone who could link us up with somebody who sells drugs.
We met a man going by the name Bvumbulutso who said he sells fertiliser at the trading centre. Bvumbulutso said Drug Baron had left the area, but he could help us anyway.
“Drugs are not my line of business. But don’t despair, I will find some for you,” he said.
As the conversation wore on, Bvumbulutso’s eyes and general body language spoke of a man stricken by fear and suspicion for talking to a stranger who had come to buy a ‘sensitive’ commodity.
“Stay here, let me go around and get the drugs for you,” he said as he left our meeting point.
After about five minutes, he reappeared, only to ask: “You want to buy in bulk? I have not been able to trace the man I was looking for. I met his wife who is afraid to sell the drugs in bulk. She said only her husband can sell the drugs in bulk.”
All the while as we were talking to Bvumbulutso, a man sat at a distance, listening in to the conversation.
Unexpectedly, the man shouted to Bvumbulutso: “Nyambalo man,” meaning the reporter was an undercover agent who was in the area to spy on the people who sell drugs.
It was time to be streetwise. To convince him that we posed no harm, we pretended to make a call to somebody attending to a patient who needed the medicines.
Mellowed by the pleas, Bvumbulutso said: “Ndipatseni ndalama yochepa yokha [K1 000] ndikakutengereni mankhwalawo, ngati mufune ena mudzapita nokha. [Just give me a little money, no more than K1 000 (about $3). I will get the drugs for you. If you want more, then you will go there yourself].”
Then he went away for a while before returning to fetch the reporter to his shop. While in the shop, he demanded to have the reporter’s mobile phone number. He called the number and, satisfied that it was genuine, he left the shop to buy the drugs.
After a little while, he returned with the drugs and gave instructions for the prescriptions. He brought 41 tablets of Buffen, Panado (36 tablets) and anti-malarial medicine, LA. There were 12 LA tablets for children and an adult dosage of 36 tablets.
“People come all the way from Lilongwe to buy drugs from [Drug Baron] and others. In fact, I have been asked to look for buyers,” he said.
As we left the trading centre, Bvumbulutso’s face was a seat of worry and apprehension as he feared that he could have been talking to a police agent.
Later, the reporter understood Bvumbulutso’s fears.
“Last year, police came here and arrested the people who sell drugs, so they are always suspicious,” said a bicycle taxi operator as he carried the reporter away from the area.
But Ntcheu Police deputy spokesperson Laston Chapansi said the clandestine drug trade was news to him. Chapansi said police would investigate the matter.
In Chemusa Township in Blantyre, it is another showcase of creativity and street smarts that characterise the drug trade.
Trick: Keep your eyes and ears open and don’t take anything for granted.
On a rainy Thursday afternoon, our search for drugs reached the township’s market. We asked around for people who sell medicines in the area.
A woman gave us instructions: “Go inside the market. When you find an empty carton that looks useless, it is a sign that they sell drugs around. Just stay there; somebody will come over to sell the drugs. You can’t find drugs anyhow here,” she said.
Some metres after we entered the market, a small carton came into sight. We made for it. After spending about a minute at the spot, a boy came over with a black shopping bag containing bactrim.
The drugs were selling at K40 per four tablets.
When we explained the packaging of the drugs to principal secretary in the Ministry of Health Dr Charles Mwansambo, he sounded shocked as he confirmed that they were drugs from public hospitals.
Mwansambo said drugs for public hospitals are sold in packages while those meant for other health institutions are sold in single tablets. He said some drugs for public hospitals bear the government stamp.
“Those are our drugs. Are you sure you have bought them from vendors? Surely, we will do something about the issue,” said Mwansambo.
A spot check at some pharmacies in Blantyre revealed that they sell 20 tablets of Buffen and Panado at K150 (about $0.44), while a full dosage of LA goes at K2 000 ($6), but in Ntcheu we bought it at K600 (about $1.76).
For people who depend on Lumbadzi Health Centre in Lilongwe and Mbela Health Centre in Balaka, hope for reliable medical care is in short supply.
Lumbadzi Health Centre is responsible for 197 villages that surround the facility and conducts 160 maternity deliveries per month.
The outpatient department waiting area is usually thronged with people seeking medical attention, but last Wednesday, there were only three people, apparently because most people have given up on the facility given its constant lack of basic drugs.
Posing as a patient with malaria symptoms, the Nation on Sunday reporter joined the queue of waiting patients.
But no sooner had the reporter taken his place on the queue than a watchman told him that there was little hope at the health centre because there was no medicine.
Interviews with guardians, patients and staff insiders at the health centre revealed that the facility only had Quinine, which can only be delivered intravenously. There was no Bactrim, Panado, Aspirin and malaria drug, LA, among other basic and essential drugs.
“My daughter was struck by malaria at school. We came here and they gave her Quinine, but we have to buy the painkillers ourselves,” said a guardian nursing her sick daughter, who did not want to be identified.
At Mbela Health Centre in Balaka, John Khalira had just left the clinic around 10:30am. Khalira, who lives at Makuta Village, T/A Kalembo in the district, had a swelling on one of his fingers.
In addition to his condition, he also went to the health centre to seek treatment for his daughter who had skin rashes.
“I thought they would give me Indocid or Buffen, but the doctors said they do not have the drugs at the health centre.
“For my daughter, they have prescribed some drugs, but the medicine is out of stock. What this means is that I have to source between K500 (about $1.47) and K700 (about $2) to buy the drugs. I don’t know how I will find the money,” said Khalira who received bactrim.
“Unfortunately, Balaka District Hospital is over 15 kilometres away from my village,” he said.
If only Khalira and other people living around Mbela and Lumbadzi health centres were as lucky as those who seek medication at Mzuzu Health Centre, they could walk home with a little smile.
Acute drug shortage
Patients and medical officers interviewed at the city health centre on Thursday said the facility has essential, but not vital drugs.
While we were there, an ambulance from Mzuzu Central Hospital drove away carrying three cartons of assorted essential drugs.
Asked why a referral hospital was carrying drugs from a health centre, a nurse at the clinic said Mzuzu Central Hospital usually runs out of drugs mainly because the city has no district hospital.
The nurse said the centre has two sources of drugs—Unicef and Mzimba District Hospital—hence the availability of medicines.
But the case of Mzuzu Health Centre is an exception to the rule in Malawi as the drug shortages bite indiscriminately.
So critical is the situation that recently doctors at Kamuzu Central Hospital in Lilongwe took the unprecedented step of writing an open letter to President Joyce Banda and the people of Malawi to find urgent solutions to the problems.
The doctors’ later forced Minister of Health Catherine Gotani-Hara to admit that the drug crisis has left the country with a 95 percent stock-out of essential drugs, especially in district and central hospitals. But while the drug crisis has concentrated on urban and peri-urban areas, rural communities, the majority of whom live below the $1 (K360) poverty line, are in their own hell hole.
A study by the Overseas Development Institute (ODI) on the supply and distribution of essential medicines in Malawi released early last month found that despite the formal policy commitment to free essential medicines, on average, 75 percent of facilities are thought to have experienced significant drug stock-outs in recent years.
The ODI report also quotes a 2012 Oxfam study which found that only nine percent of local health facilities (54 out of 585) had the full Essential Health Package (EHP) list of essential drugs; clinics were frequently out of basic antibiotics, HIV test kits and insecticide-treated nets; and stocks of vaccines had run “dangerously low”.
Another 2011 report found that high levels of critical medicines in the EHP were not available: only 27 percent of health facility managers surveyed considered cotrimoxazole (which treats acute respiratory tract and other infections) to be of sufficient supply in their facility; 60 percent had insufficient stock; and 13 percent of facilities were completely out of stock.
The ODI warns that stock-outs of essential medicines can contribute to a number of challenges for the Malawi health sector.
Says the report: “Where health facilities experience stock-outs of essential medicines, they may be available only at private providers. As a result, medicines are more expensive [and may be less available]. Service users do not receive free essential medicines: they may be forced to use these private or informal providers or have to go without. Moreover, there appears to be significant district-level variation in terms of availability and cost of medicines, which results in inequity of service delivery.”
In a meeting with President Banda that followed publication of their letter, the KCH doctors blamed the crisis on inadequate funding, long and bureaucratic procurement processes, the centralised health system and use of intermediaries to buy drugs.
Executive director of Malawi Health Equity Network (MHEN) Martha Kwataine on Wednesday said the drugs shortages are an infringement of people’s right to health.
“The challenge we have is that such incidences result in loss of trust in the health care service delivery of our public hospitals. As a nation, we’re sending contradicting messages by telling people and mothers to access services in our public health care facilities and yet there are no medicines,” said Kwataine.—Bobby Kabango reported from Ntcheu, Blantyre and Balaka; Bright Mhango reported from Lilongwe while John Chirwa covered the story from Mzuzu.