Afghans Complain of Substandard Medicines

For eight months Iqbal, a resident of Khost in southeast Afghanistan, dutifully took the medicine his doctor had prescribed him, but his condition did not improve.

Finally, he travelled over the border to Peshawar in Pakistan and sought a second opinion. Doctors there diagnosed him with the same illness and recommended identical treatment.

“I told the doctors in Peshawar that the medicine they were giving me was the same as I’d been prescribed in Khost and which hadn’t made me recover,” Iqbal said. “When I took the [new] medicine until it was finished, I got better.”

After he returned to his Pakistani doctor and received a clean bill of health, he asked for an explanation.

“He told me that the diagnosis by the doctors in Afghanistan was correct, but the medicines were unsatisfactory,” he said.

Out-of-date or counterfeit medicines, often administered by under-trained doctors, are a serious risk to public health across Afghanistan. The problem is especially acute in provinces like Khost, where a common border with Pakistan provides rich opportunities for smuggling, including substandard pharmaceuticals.

Khost resident Mohammad Taib said that he had been to various doctors with the same common malady and had been diagnosed differently each time.

“Quite simply, we have neither doctors nor medicines,” he said. “They just play with people’s lives.”

Khost doctor Abdul Qader Sayar said it was not the skills of Afghan medics that were deficient, but the medicines available to them.

“We have doctors who have treated patients abroad, but when we give patients medicine here, they do not recover. The reason is that the medicines are inferior.”

Enayatullah, a doctor originally from Khost who is now studying for a dermatology specialisation in India, says that has been his experience, too.

“When I prescribe medicine for someone in India, they recovers, but if I do the same in Khost, the patient doesn’t get better. The reason is substandard medicines, which has made people distrust domestic doctors,” he said.

Enayatullah pointed out that the Indian government had a quality control programme for pharmaceuticals, whereas widespread corruption in Afghanistan made this impossible.

None of the Khost pharmacists whom patients and doctors accused of selling fake medicines would give IWPR an interview.

THRIVING CROSS-BORDER TRADE

According to the pharmacy office of the provincial health department, 40 to 50 per cent of all medicines available in the province have been smuggled in from Pakistan.

Hedayatullah Hamidi, the acting director of public health in Khost, said attempts to combat the trade were being hampered by a lack of testing equipment.

“If we have the machine needed to check medicine quality, we will be able to prevent the smuggling and use of low-quality medicines to a large extent,” he said, adding that he had repeatedly asked for – and been promised – such a device, but yet to receive one.

Hamidi said the length of time the quality control process took was also a problem.

“When medicine reaches customs, the trader brings a sample to the public health directorate,” he explained. “The directorate sends the sample to Kabul for checking. The results come back from Kabul in a month. This costs the trader a lot, so no one wants to import medicine legally and they resort to smuggling.”

The cross-border trade is damaging legitimate importers and producers of medicines in Khost.

Sultan Mangal is a representative of the Khost branch of Pakistan’s ATCO Laboratory Ltd., one of about 20 pharmaceutical companies registered with local government.

He said that while his company paid tax and imported reputable products, they were undercut by fake medicines trafficked from North Waziristan, Bannu and Peshawar in Pakistan.

“The smuggled medicines have the branding of our firm and other credible companies on them,” he said. “They look just like the original. They are sold at cheap prices. Our genuine medicines sell for slightly more, so they don’t find buyers. The market in poor-quality medicines has badly damaged our business and our credibility.”

Gul Mohammad Babrakzai, head of the provincial health department’s pharmacy office, said every effort was made to monitor state and private hospitals, clinics and pharmacies on a weekly basis..

“We seized one tonne of low-quality, out-of-date medicines last year and our investigations into them are ongoing,” Babrakzai continued. “We have fined up to 25 pharmacies sums of between ten and 100 dollars. We have referred three clinics to the attorney’s office for selling low-quality medicines, and one of them has been shut down permanently. Three others have been closed for nine days.”

Babrakzai added that his department was on the trail of a number of Pakistani pharmaceutical smugglers.

“We have carried out several operations to arrest them, but we have failed to do so. We are still pursuing them,” he said.

Babrakzai criticised the Afghan customs service for failing to search lorries properly as they came across the border.

“We have shared this problem with customs, but they said they didn’t have the facilities or space to unload all the trucks and check them,” he said.

ALLEGATIONS OF OFFICIAL COMPLICITY

Mangal accused Afghan public health officials and the local security forces of either taking part in the illicit trade or turning a blind eye to it.

Local residents also told IWPR stories of police taking bribes in return for allow vehicles to pass unchecked.

Security officials insist they are making sincere efforts to counter smuggling.

Border police commander Abdul Basir Khpalwak says his men prevent trafficking in both directions.

“The border police are committed to their duties. They don’t let anyone act illegally,” he said, adding that many smugglers had been arrested and prosecuted.

Khost’s overall security chief Mohammad Yaqub Mandozai said there was good cooperation between police and customs. “We are making maximum efforts,” he added.

Ahmad Shah is an IWPR-trained reporter in Khost province.