Do-It-Yourself Healthcare

Poverty and a shattered healthcare system forces many in Kabul to take their chances with roadside medicine sellers, underqualified pharmacists and quack doctors to treat their ailments.

“Any problem that people face [from my medicine] is the responsibility of the buyers,” shrugged Halimullah, 15, as he sells drugs from a basket in central Kabul.

He seemed to be doing a brisk business. “Old, young, women and men, all come to buy medicine from us,” he said.

Halimullah said he and his father buy the drugs at a wholesale shop and then sell individual tablets to anyone who asks.

Agha Sherin, 17, who sells a selection of medicines outside the Pul-e-Khishti mosque, said that his patrons are mainly the poor and the uneducated, often passing the names of different painkillers and sleeping pills around among themselves.

He said he also provides medicines to shopkeepers in several villages, who then sell it to other customers. He claimed he has not heard of anyone having an adverse reaction to anything he has sold.

But Abdul Baqi Bashiri of Ghazni tells a different story. He said his brother, Mohammad Jamil, has never been the same since taking a dose of malaria pills three years ago.

Whatever he took seems to have affected his brother’s brain, Bashiri said. Mohammad Jamil now does little except talk to himself.

“Our remorse and regrets don’t achieve anything,” Bashiri told IWPR, “but I request everybody not to take medicine without a doctor's prescription.”

However, sometimes it is unqualified doctors that are the problem.

In the Sarobi district, east of Kabul, Mullah Sayed Mohammad said that a man who had been acting as village physician had completed only a primary school education and a basic first-aid course.

He was run out of town after a series of medical mishaps.

Sayed Mohammad said that his own son was left with a crippled leg after receiving an injection from the man, who had reused the same needle many times.

“Sometimes when the syringe got blunt he sharpened it with a stone,” he said. “With great difficulty he would pull the patient’s flesh and inject him.”

Saamia Hamkar, 38, in the Bamian province, never sought any kind of medical advice until “one day I had a heavy cough, so my husband advised me to take some medicine and I took some syrup from our cupboards”.

As a result, the teacher said, “I miscarried my child and faced other problems as well.”

At Maiwand hospital in the centre of Kabul, Dr Enjila said she sees patients brought in vomiting after taking medicines which by law should only have been provided by prescription.

Such problems are even more acute in the villages where there are often no trained personnel, said Dr Mohammad Kazimi, the head of the pharmacy department at the ministry of health.

In such places, those with even the slightest medical knowledge are revered. “In the land of the blind, the one-eyed man is king,” said Kazimi.

But with few resources, the ministry seems unable to halt the unauthorised sale of medicines. And given the level of poverty in the country, many people feel they have no choice but to use unqualified doctors or buy medicines on the street.

“I don't have any money,” said Rahmatullah, a day labourer in the construction industry, as he stepped out of a pharmacy near Maiwand hospital. “The doctor’s fee is 80 or 100 afghanis. There is no labouring work and my wife, who was pregnant, lost a child two months ago because of our poverty. I go directly to the drugstore without a prescription and buy the medicine I need.”

Although health care is supposed to be provided free at the state-run hospitals, Rahmatullah said doctors often insist that patients attend their private clinics. Once there, these patients are not only charged for the consultation but also must buy expensive medicine.

Pharmacist Mir Inayatullah, who studied at Kabul University, blames the lack of money, doctors and clinics, as well as the high rate of illiteracy in the country, for the booming market in under-the-counter prescription drugs.

In his own store, Inayatullah insists he won’t sell such medication, especially drugs used to treat typhoid and malaria, to people without a prescription.

Others, however, are less demanding.

Kamaluddin, 18, said he was filling in behind the counter at his family store. “Until we hire a new pharmacist I will be doing the pharmacist's job,” he told IWPR. “Nobody I have sold medicine to so far has had problems.”

Rohullah Babekerkhel and Shahbuddin Terakhel are independent journalists in Kabul.