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Pamela Mason, is a pharmacist and
freelance writer from Abergavenny, Monmouthshire
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The need for medicines management in the aftermath of the Boxing
day tsunami in South East Asia is huge. But what is needed is not the
sort
of medicines management that UK pharmacists understand. Donated medicines
in the affected areas are stockpiling by the tonne and they need to be
sorted and stored until they can be used appropriately or discarded.
Banda Aceh was devastated by the tsunami |
There
is certainly no need for any more medicines, one pharmacist working in
the Indonesian town of Banda Aceh told me. “It’s a challenge
to manage those we’ve got now, never mind any more.” Indro
Mattei, a pharmacist from Lugano in Switzerland, has been in Banda Aceh
since the middle of January. No stranger to disaster relief, he has worked
in several parts of the world, most recently in Serbia and Albania. His
regular job is as a community pharmacist in Bellinzona, a large town
on the Swiss-Italian border, but he makes himself available for work
in emergency situations world-wide.
In Indonesia, he is working on behalf of the department of health as
part of a tripartite agreement between the Swiss Agency for Development
and Co-operation (a federal government organisation), Pharmaciens Sans
Frontières (PSF) and the Australian government’s overseas
aid programme AusAid. There are two main parts to the pharmaceutical
work: management of drug donations and rebuilding the pharmaceutical
sector. His main involvement is with the former.
Mr Mattei told me that the main public health needs now are for human
resources and storage facilities for donations. Banda Aceh lost 160,000
people in the tsunami. Without these people, it is difficult to rebuild
the infrastructure and provide all the required health and public services. “Pharmacists,
doctors, nurses, fishermen, shop keepers — many were killed in
the flood,” he said. “Soon after my arrival here, I noticed
pharmacy fascia boards lying on the ground in the midst of the rubble.
Other pharmacies were still standing, but had not reopened.” In
Banda Aceh, the flood devastated the wealthiest part of the city, so
it seems that mainly private pharmacies were affected. Some state-run
pharmacies in other areas of town are functioning.
The gap in human resources is being filled to some extent by the Indonesian
government which is sending professionals to Banda Aceh on a rotational
basis for 10-day periods. “But it is not enough,” said Mr
Mattei. “We are really struggling”. Though many non-governmental
organisations (NGOs) are active in the region, they are not as effective
as local people, he added.
Although NGOs tend to be like-minded, they tend also to be individualistic
and competitive. There are those who suspect that some of the foreign
workers are there primarily because of their own need to help rather
than to help with need. Ghislaine Soulier, spokesperson for PSF, expanded
on this. “The governments of affected countries do not dare to
refuse donations for fear of offending donors. It is difficult to say “no” to
people who are convinced that you need them, especially if you feel that
they need you to need them.”
PSF has been working in the tsunami region since early January. A report
it published last week on the drugs situation there comments: “In
the rush to provide relief, the same mistakes are systematically made
over and over again. We saw exactly the same thing in Bosnia and Albania.” The
document goes on to ask why governmental, inter-governmental and non-governmental
humanitarian agencies do not get together to discuss the situation. This
would ensure that help is properly targeted, effective and avoids penalising
recipient countries with inappropriate donations that they will have
to destroy to protect the health of their people. “In the age of
communication, why is communication so difficult,” questions the
report.
In Banda Aceh, in the days immediately after the tsunami, some of the
real needs included cleaning the streets and burying the dead. Apparently,
many NGOs were in no rush to help in this type of work. Although dead
bodies are not a serious source of disease, digging graves was still
a job that needed to be done. Moreover, the arrival of thousands of humanitarian
workers — some of whom could be described as “humanitarian
tourists”, according to a letter to the BMJ last week — is
threatening to destabilise the whole region, creating inflation and pushing
up prices to a level that the local people cannot afford. Mr Mattei told
me that Banda Aceh is now the most expensive city in Indonesia. “A
month’s rent here is the same as a year’s rent in Jakarta.” In
spite of the loss of 160,000 local people, the city is busy, buzzing
with aid workers, he said. This reminded me of the so-called “rush
hour” I had witnessed in Kosovo in 1999, which consisted of a huge
line of NGO vans queuing to get through the only working traffic lights
in Pristina.
There are no acute health needs in the city of Banda Aceh now, although
there are in the outlying areas, said Mr Mattei. “Certainly we
don’t need any more drugs. People with physical trauma caused by
the flood have either died or have largely been treated, he explains.
Millions of doses of antibiotics will go to waste. The PSF report claimed
that a warehouse the size of a football field is needed to store the
unneeded drug donations. “This is true,” agreed Mr Mattei. “The
problem is that we haven’t got such a warehouse.”
However, not all the drugs are inappropriate, he explained, although
it is difficult for workers who cannot understand, for example, labels
written in Portuguese. The news in Banda Aceh is that there are also
several ships waiting out at sea to bring in more donations. “How
true that is we don’t know,” said Mr Mattei. But I gained
the impression that the arrival of such donations, certainly drugs, would
only add to the medicines management difficulties and public health hazards.
It is a costly exercise to dispose of unwanted drugs. In any case, the
local pharmaceutical companies can supply all the required medicines,
and there is a significant generics industry in Indonesia.
In the city, building reconstruction has begun in earnest. “These
are tough people,” said Mr Mattei. “I have been impressed
at the speed with which they are rebuilding. When I arrived, people were
living in tents. Those still without homes have moved into barracks,
but houses are shooting up, shops have reopened, the children are back
at school.”
But there are many challenges still to face. Reconstruction of efficient
health and pharmaceutical services will take some time. Sorting out,
storing and disposing of the tons of unwanted medicines is the main priority.
Pharmacists here, as in every other part of the world, can make a difference.
But pharmacists who want to contribute in emergency situations should
carefully consider the organisations and structures within which they
have an opportunity to work. There is no room for “pharmaceutical
tourism”. The real needs are too great. |
The
Pharmaceutical Journal