According to the local newspapers there is a drug crisis in Malawi. There is a 95% shortage of medications which they define as hospitals and pharmacies having only 5% of their needed inventory. Not only funds to buy medications is an issue but also the suppliers do not have sufficient stocks to distribute even if one has the funds to purchase them. The picture on the left and in the middle, at the top, depicts the extend of the variety of medications that is available at the outpatient pharmacy of the hospital in Nguludi. Malaria, TB, HIV are the most common medical conditions seen at the hospital. There are only a few people presenting with CVD but remember the the life expectancy is only about 46 y.o. The only oral medication available for diabetes is metformin and insulin. Insulin is a challenge with the problems with refrigeration and frequent power outages. For pain, there is basically only acetaminophen, ibuprofen, and oral short-acting morphine. There was tramadol at some point but there has been no supplies available for a while. Morphine is available from the government at a very subsidized cost (the hospital pays 12.5% of the actual cost) but availability from the central supplier is patchy.
The actual process of dispensing medications is very different from what we are use to. At Nguludi there is no pharmacist but they have a pharmacy technician which is more than most hospitals can say. A clerck dispenses the medication in the outpatient pharmacy, she is all by herself and may be seeing 40 -60 patients a day. There is no checking process in place. The medication are provided in small plastic bags (see picture top right) which has pictogram for morning lunch supper and bedtime under which she indicates the number of tablets to be taken and for how many days someone needs to take their medication. In the city you can get most medications without a prescription with possibly the exception of antibiotics and morphine. Physicians are very rare to actually prescribe medications and only very basic ones are available. When locals get a fever they assume that it is malaria and treat themselves for it. If it does not get better than it most be another infection of some sort and then seek medical attention. Very few diagnostic procedures are available so that when people have cancer it is detected very late.
I have heard today that sometimes people bring medication as donations but it sometimes remains untouched due to unfamiliarity with them. A lesson to be learned. If you ever consider volunteering as a pharmacist and consider bringing medications there is a good document from the WHO which addressed best practices. Do not bring samples being one of them. If bringing medication bring some that the people will be familiar with and that they have on their national formulary, etc.
Yesterday, there was a child seizing on a ward, and a nurse arrived flying in the pharmacy to know how to dilute it so she could administer it. No reference books available in the pharmacy, no access to the Internet on a regular basis, no package inserts in with the actual medication,…
Today there was another child who had swallowed a coin which got stuck in his throat. They started operating on him to remove the coin but the power ran out, so the child had to be woken up and transferred to the larger district hospital.