For some days now, news of a teenage girl, Amina Ibrahim, who died of Stevens-Johnson Syndrome, has become the talk of medical parlance, and of national concern. The poor girl ended up a consumed prey of this rare medical condition after being attended to, for cold and cough, by a quack chemist who, shortly after Amina was terribly down with this condition and was no more, disappeared into thin air. This occurrence, albeit very unfortunate, is very didactic for the Nigerian populace as far as rational and irrational drug use is concerned, and points to the very reason why qualified health care practitioners should, under all circumstances, be our first and last point of call for any of our health issues, and more importantly, why it behoves the medical personnel to improve their modus operandi.
Aforementioned rational drug use, which I believe to the medical world rings a bell, is what the generality of Nigerians should understand, and probably be made aware of in the manner of their peculiar pecuniary awareness; because as it is today, drugs still form a major part of medical therapy. Rational use of drugs demands that ” medicines be taken based on patients’ clinical requirements, at doses sufficient for their individual needs, for an appropriate period of time, and at affordable cost for them and community”.
Irrational use of drugs is not a problem peculiar to Nigeria but, in fact, a serious global menace. WHO stipulates that half of all medicines are inappropriately prescribed, wrongly dispensed, insouciantly sold, and half of all patients fail to ensure correct and adequate compliance. Irrational drug use does not leave out overuse, underuse, and misuse of medicines; the use of too many drugs for a patient ( poly-pharmacy ), administration of antimicrobials for non-microbial infections, the use of injection when pharmacotherapy will be achieved with oral, self-medication, the use of medicines for unintended purposes, and general aspect of drug abuse.
In Nigerian context, given the above definition and aspects of rational and irrational drug use, it is quite clear and obvious that irrational use of medicines is commonplace in our society, and which, with little or no attention meted out on it by medical professionals and the government alike , has, pitifully, continued to soar to the detriment of Nigerians.
I, like preponderance of poor Nigerians, have been an indirect victim of irrational use of drugs. I remember about seven years ago, one of my closest relatives received antikoch ( TB drugs) for nothing less than five months before it was later found, using more complex diagnostic measures, that the person in question did not have Tuberculosis. Though before the commencement of the regimen, the sputum test for the condition gave negative result, she was, nonetheless, placed on the said drug. Many people, out of ignorance and inadequate enlightenment, have become addicts, buying and using drugs in a bid to improve their performance at work. Witnessing all this scenario of drug misuse has been one of my experiences during my industrial training as a pharmacy student, and often times, I had to explain to people why depending on drugs to perform maximally at their daily work was not the way to go. Sometimes, we had risible cases of people looking for tramadol to arm themselves before their salacious visit to the brothel.
I would not be amazed if statistical data reveals that Nigeria loses more people yearly to deaths culminated from irrational use of medicines than deaths from traffic accidents, especially if developed nation like U.S., given its technological wizardry and sheer medical advancement , could, according to CDC ( Centers for Disease Control and prevention), record an historical 2.8 – fold increase in total number of deaths from prescription drugs from 2001 to 2014, then probably, it would not be far off to assert that “Pharmageddon” – period when medicine and its use would fetch more ill-health than health- is already, or at best, will soon be upon on us.
Misuse of medicines pervades the nooks and crannies of our society; a common practice among both the illiterate and the gentry. This misuse is exploited for myriad of purposes; boosting sexual performance, for pain relieving, euphoria, improving work strength, for false sense of wellbeing (” to get high”), sedation, for keeping awake, etc, and the vast number of people, from all walks of life, involved, is a pointer to the crystal-clarity of the epidemic nature of this “Plague”. Having said this, some people, however, have partaken in irrational drug use not for the above-listed exploits, but out of ignorance, abject poverty, carefree attitude, etc.
When blaming the goose, gander should not be exempted. The REAL culprits of irrational drug use are not only the quack chemists and patent medicine sellers who parade themselves as medical doctors, but also the qualified health care professionals who, for one reason or the other, perennially fail to conform to their professional ethics. For instance, I know of some health care institutions where patients’ relatives are given undue and unethical access to confidential medical files of the in-patients. When these patients need any drugs, but not available in the hospital pharmacy, the patients’ relatives would be given the file to search for the drugs outside. This practice, as witnessed in the hospital where one of my friends undergoes his 12-month internship programme, always gives room for any drug addition, subtraction, or alteration on the file by the bearers. Also, the out- patients are generally allowed to go home with their prescription papers and get their drugs wherever they may, even if patients are prescribed controlled drugs like narcotic analgesics. As expected, this has never failed to yield detrimental consequences because, henceforth, patients go about using the same prescriptions for subsequent purchase of drugs.
Patients, who, despite their going to the hospital, have had their medical conditions worsened and probably died due to wrong prescription and dispensing of drugs for wrong or yet to be diagnosed indications, are numerous, and major contributors to this great number have partly been occasional non-performance of necessary tests and examinations, professional negligence on the part of medical personnel involved, wrong diagnosis, large patient to doctor ratio which results in hasty prescription, and unhealthy lack of communication between health care practitioners which frustrates team work and puts patients in the danger zone; where two elephants fight, the grass there suffer.
Sometime recently, there was public outcry about some Nigerians who were about to be executed by Indonesian government for illegal drugs trafficking. Before and after this incidence, we had had cases of many Nigerians partaking in hard drugs trafficking, and for the reason known or vague, the trend can only continue to climb, given the widespreadness of irrational use of medicine in our country. When drugs are being handled like foods that you can easily go to the market and get, then we can only expect the attending consequences. Psychiatric cases, reckless driving by commercial drivers and riders, drug traffickings, rapings, social and political thuggery, disturbance and threat to public peace and security, vandalism,and other anti-social activities, are what that can never be found wanting in a society, like ours, where irrational drug use has become a culture.
Health care personnel should endeavour to always be ethical in their professional dispensation. The drug custodians, pharmacists, should let the mere handling of medicines to the patients be a thing of the time of yore. Drugs are chemicals which have potential to benefit or harm the body system; a common knowledge among these ‘men of honour ‘ which I don’t think I need to tell them but feel their patients gravely need to be told. To this end, therefore, comprehensive provision of information on drug side-effects, uses, proper mode and manner of administration, storage, interaction with other co-administered drugs, compliance, etc, will immensely ensure drastic reduction of deaths resulting from medications. Also, performance of necessary tests and examinations, avoidance of hasty prescription, ensuring correct diagnosis, forging healthy rapport through effective communication, inter alia, are matters of utmost saliency which, I’m sure, our doctors know are very crucial in bettering the lot of their patients.
Reduction of patient to health care personnel ratio, provision of world-class medical equipment, availability of funds for the organization of public enlightenment and education on the evil of irrational drug use, proper and implementable policies and legislation against drug abuse and misuse, creation of conducive environment for active and better participation of NGOs and parastatals in the ‘war’ against irrational use of medicines and related crimes, all these, if the government is really interested in saving its people from this ‘boko-haramic’ menace that threatens the size of our country, then, are worth its urgent attention. Our numerical strength, if greatly harnessed, can breed our greatness. So, nothing should be allowed to tamper with it.
People should learn to live naturally without drugs except for the utmost end of need. Swallowing painkillers and antibiotics for slightest body pain is no brainer, and parading ourselves as self-doctor or pharmacist is suicidal. Paracetamol, to many, is peanut, unbeknown to them that it’s hepatotoxic ( has potential to damage liver), while few people know that vitamins from natural sources are way better than vitamins capsules or tablets. Eating balanced diet; staying away from fast and canned foods, regular physical exercise, living in adequately ventilated place, cultivating habit of excellent personal hygiene, reducing stress through sufficient rest and positive thinking, cutting down on alcohol, abstinence from smoking, strict avoidance of refined sugar found in soft drinks (refined sugar contributes to insulin resistance which is highly implicated in diabetes), can keep us away from drugs altogether and save us from their adverse effects.
I will not say creating an El Dorado out of our society is an impractical utopia. Giving this “winged beast” a serious and onerous combative confrontation will in no measure go a long way in fighting this our common “enemy” and creating a perfect or semblance of a perfect society of our own.Not possible? Let’s try first and see how far we get. Like one of my friends would say: “not everyone is infected but surely everyone is affected”. Therefore, the war on irrational drug use is a collective battle of the health care professionals, government, and as well as the generality of Nigerians.
BY OMOTOSHO MUIDEEN TITILOPE