Medicine Racket Endangering Lives

Along one short section of road in Peshawar's University Town, a residential area in the centre of the city, some 130 shops sit side-by-side selling pharmaceuticals. No more than a dozen have licences and even that is no guarantee they are dispensing drugs that work.

"Because of a lack of education most of our population don't know that treating themselves can endanger their health," said Professor Dr Saeed-u-Din Sharafzai, head of internal medicine at Peshawar's Afghan University. "The government should take action against the illegal drug stores and make sure all pharmacies sell real drugs and just on doctors' prescriptions."

The problems are manifold: there are drugs no longer allowed elsewhere in the world; those long past their expiry dates and fake ones that are useless confections produced in small local factories, stuffed into capsules and placed in copies of original packing.

Further complicating matters is that there is no control over the quality, distribution or pricing of pharmaceuticals. Anyone can set up shops, dispensing to gullible members of the public who indiscriminately consume those they think will help them.

"We accept that this is a growing issue and we are doing our best to control it," said an official of the district health organisation. "But, at the same time, we haven't got enough resources."

In a survey of 120 pharmaceutical shops along a main street in University Town, many openly admitted they had no licences, saying their knowledge of drugs was gained by spending a few weeks with a doctor or technician. More than half said they bribed drug inspectors to look the other way.

Most of the shops offer drugs that have been dropped from the international list of acceptable pharmaceuticals. And, of course, customers do not need a prescription to buy any steroids, antibiotics, poisons, tranquilizers, sedatives, or hormones.

"Many of the medical stores have connections with local illegal companies that supply them with poor quality drugs, which gives good profits to the store owners," said Dr Zahid-u-Din, director of the Afghan Teaching Hospital. "These drugs are ineffective and won't produce results but until the government acts we can only warn people."

Members of the public buying pharmaceuticals that have no effect may be lucky. Worse off are those who take inappropriate or faulty drugs or ones that have been removed from the market in better-regulated parts of the world.

In the Hayatabad Medical Complex Hospital, in an area of Peshawar that developed after the influx of Afghan refugees began in 1980, 15-year-old Toryalai lies in bed suffering from aplastic anemia - anemia of the bone marrow - following an overdose of an anti-malaria drug handed out at a clinic three months ago.

Mohammad Ismail, an Afghan refugee living in Shamshatoo camp near Peshawar, died last month at the age of 26 during what should have been routine surgery, his cousin Abdullah said. "The reason for my cousin's death was that he was given expired anesthetic for a nasal polyp operation," said Abdullah, who is a medical student at Afghan University.

The indiscriminate use of drugs has also steadily eroded their effectiveness, with new drug-resistant strains of diseases appearing. Doctors in Peshawar are increasingly worried that pharmaceuticals they prescribe will be useless - either because the drugs are faulty or because they have become less effective through over-use.

"In the past, drugs were more beneficial and effective but now I have noted so many cases, especially post-operative infections, due to the worse quality of drugs, especially antibiotics," said Dr Omar Gul Mohammad, head of surgery at Jehad Hospital, at Pabo refugee camp outside of Peshawar.

"Because of the lack of control, the number of both legal and illegal pharmaceutical companies is increasing very quickly so it is very hard to know which one is best and produces good quality drugs."

Dr Baray Sidiqui, head of the Afghan Doctors Association in Peshawar, wants Pakistani authorities to tighten controls - raising the qualifications required and enforcing the rules for operating a pharmacy. He says the association is ready to help since doctors know those operating illegally or selling dubious drugs.

But Pakistan is like many other poor countries facing problems with pharmaceuticals. Corruption is rampant, few rules are enforced and expectations for better regulation of drugs are low.

In Nasr Bagh, a teeming Afghan refugee camp with around 100,000 people, on the edge of Peshawar, the owner of a pharmacy listed his margins on various products. Since those from firms identified as distributing questionable drugs gave the highest profit, the shopkeepers in University Town are unlikely to change their practices.

Noor Muhmand Aminullah and Shams-ur-Rehman are attending the IWPR journalism training course in Peshawar.