Bitter Medicine in Helmand

Falling ill in Helmand province of southern Afghanistan is a risky business, as the cure can be worse than the ailment itself, Residents say unregulated sales of pharmaceuticals, often administered by poorly-trained medics, pose a serious threat to people’s lives.

Medicines well past their sell-by date are smuggled in from Pakistan and sold on the open market in Helmand and other parts of Afghanistan.

Bahlol Khan was in his chemist’s shop in Lashkar Gah, the main town in Helmand, when a young man rushed in and asked him to come and help his mother.

On arriving at the house, he discovered that the woman had lapsed into unconsciousness after taking a drip preparation her son had bought. The chemist stopped the drip and rushed the woman to hospital after spotting that the medicine was a year past its expiry date.

“Those who sell expired medicines are murderers. They fear neither government nor God. They trade on people’s lives,” he said. “I wouldn’t sell expired medicines in my shop even to avoid dying of hunger.”

Doctor Mohammad Ashraf Naderi said he saw patients every day who came to him after taking out-of-date pharmaceuticals.

“We treat many of them, but some of them die as a result of these medicines, or suffer complications that mean they have to go abroad for treatment,” he said.

He said people often wrongly blamed the medical professionals who had prescribed drugs without knowing that those on sale were no good.

“The doctor diagnoses the illness and prescribes the necessary medicines, but when a pharmacy gives the patient poor-quality or expired medicines and the patient doesn’t recover or gets worse, people then say the doctors don’t know anything,” he said.

Ahmad Shah, a resident of Garmsir district, said the situation was at its worse away from the larger towns.

“There are no doctors or pharmacies in the villages. Shopkeepers there sell medicines alongside other items. Villagers come to them and tell them of their ailments, and the shopkeepers give them the medicines they have to hand. They don’t feel responsible for what happens to the patient.”

More formal kinds of medical practice were just as bad, he said, explaining, “Nurses who have completed two- or three-month courses have opened check-up clinics in the villages and they hand out medicines. If someone dies, they say it was just fate, that the person’s time was up.”

Most of the substandard or out-of-date drugs on the market come in from neighbouring Pakistan and Iran, smuggled by traders who make huge profits.

“These medicines are of zero quality. Close to 100 per cent of them are low-grade or have expired. There’s nothing we can do about it,” Dr Yar Mohammad Naseri, deputy head of public health in the province, said.

Dr Obaidollah Daudzadah, the official responsible for implementing health legislation in Helmand, said there were no facilities for testing pharmaceuticals in the province.

“We only have the one laboratory in Kabul that can determine the quality of medicines. There are no such labs in other provinces. It’s a major problem,” he said.

Noting that customs officers were ill-equipped to stem the flow, he said, “Traders bring in dozens of tons of low-quality medicines from Iran, Pakistan and other countries every day and sell them to people here. I don’t know how many people have died from this, but the problem exists all across Afghanistan.”

Dr Daudzadah said the authorities in Helmand had succeeded in seizing two tons of expired medicines in the past three months, which they then burned in public.

The problem is widespread – Afghanistan’s health ministry says they destroyed 330 tons of confiscated medicines earlier this year.

Gol Ahmad Ehsan is an IWPR-trained reporter in Helmand, Afghanistan.