Medicine gone awry

 Michael David Chidyera, Likuni Hospital's chief dental therapist and its former procurement officer confirmed that doctors tell patients to buy drugs from private pharmacies.

Eriko Sasaki, a pharmacist and procurement officer at Likuni Hospital said the hospital has, for the past eight months, failed to provide medicine to all patients at the hospital.

“We had a drug shortage at the hospital because we purchase our medicine from Europe -IDA (International Dispensary Association). Unfortunately, the ship carrying our drug consignment sank and so we had a problem,” Sasaki said.

“Some hospitals face theft,” Chidyera said, “but we do not have cases of theft here.”

Likuni Hospital is a mission hospital funded by the Catholic Church but receives some medicine from the government, including antiretroviral therapy (ARVs), contraceptives, and tuberculosis (TB) drugs.

Both Chidyera and Sasaki could not explain how government drugs are stored and administered.

The involvement of government hospital personnel in the opening of private clinics is also believed to increase the theft of drugs in the government hospitals

A government worker, who owns a private clinic in the poor area of a large Malawi city, said government drugs also find their way out of government hands through government clinics which deal with people on outpatient basis.

“There is no accountability. It is easy to request more drugs, some of which find their way to private clinics,” he said.

He said there was no mechanism to monitor the use of drugs in the outpatient government clinics because there are no static figures of patients who seek the services of the clinic.

“Controlling officers of these clinics would be selling government drugs to private clinics. That is where I get my drugs. These are the people we were at school together,” he said.

The Medical Council of Malawi's acting registrar, Pongolani Nsakambewa, said that although there are no specific laws restricting moonlighting, doctors are allowed to apply to the Ministry of Health to establish a private clinic as long as they would operate their clinics outside government working hours.

However, he said, the government, through the Ministry of Health, is expected to monitor whether medical personnel are adhering to the specification in the agreement with the doctors on moonlighting. He said he does not know if the government actually was monitoring.

Nsakambewa said that he knew of one physician who works at a government hospital but also runs a private clinic on the side.

Nsakambewa said the problem of drugs in the country's hospitals is compounded by a lack of facilities, a lack of resources and outright drug theft.

"Doctors have given out their best, but the conditions in hospitals are tough,” Nsakambewa said. “There is also general lack of awareness on health issues in the country. When do people visit the hospitals?"

He said Malawians only visit hospitals when they are ill. People in this country do not go to the hospital for check ups, he says. People always think that if feeling no pain is a sign of good health then they must be in good health. Many Malawians, he said, are not healthy.

"Imagine a hospital having one resuscitating machine and yet the having more than five people to resuscitate. Obviously they will die,” he said.

Nsakambewa said the main culprits in the drug theft syndicate in the country are people who work in the pharmacies.

“They are into drug theft,” he said. “A doctor only writes the prescription. He is nowhere near the drugs.”

He said the Council has no cases involving disciplining any doctor for being caught in drug theft.

Nurses Association of Malawi public relations officer Ben Phiri also said nurses have nothing to do with drug theft in the country.

“People in procurement and pharmacies are the main culprits,” he said.

Phiri said nurses would be allowed to collect some drugs for home use but that they have to undergo the normal process of diagnosis and prescription.

“They benefit in a small way. They are allowed to take some few drugs for home use. Those who involved in massive theft are isolated incidences,” he said.

Phiri, however, said his association recognizes that there have been massive thefts of drugs in government hospitals, but said they have not yet established how the theft is done.

Meanwhile, Thom Makiwa, the principal accountant at the country's biggest referral hospital, Queen Elizabeth Central Hospital, says the government's adoption of a new system - direct injection - in the procurement of drugs in country's central hospitals has improved the drug situation.

Makiwa said that the new system enables the hospital to purchase drugs directly from Central Medical Store (CMS) or private pharmacies averting the bureaucracy that has been hampering the procurement of drugs in the country.

“We do not have any problem with drugs,” he said.

Makiwa said government pumps in about K16 million every month for the procurement and that the hospital endeavours to exhaust the amount for the intended purpose.

“There have not been any complaints of drug shortage at this hospital,” he said. We have all the needed essential drugs and, with the new format, we cannot over or under spend - meaning we have the required amount of drugs.”

He said that some doctors prefer treating patients with particular drugs of their doctors' preference and that that accounts for what he calls the stories of drug shortages.

However, the hospital's principal procurement officer, William Rapken, said that hospital security is the main challenge the administration in facing.

Rapken said the hospital - at any time of the day - has more than 3,000 people, including patients, workers and guardians. But there are only about 12 security guards.

That, he says, renders the security system useless.

“A lot of things are missing from this hospital,” Rapken said. “Last months we lost 500 mattresses.”

Central Medical Stores (CMS) Senior Manager/Team Leader Charles Abondo said there were serious problems at the Central Stores.

“This place had a lot of theft, pilferage of drug leakage was rampant, and there were lots of corrupt practices here, you must be aware,” he said.

Abondo said the institution is currently undergoing reforms and about 70 percent of employees were kicked out of their respective jobs because of corruption.

Recently, Abondo said police apprehended a former CMS employee based in Mzuzu City, north of Malawi.

He says that police arrested Mkandawire for conniving with Mzuzu Central Hospital pharmacist to siphon out K500, 000 worthy drugs from the central medical stores.

“You can find corruption taking place when drugs are in transit to their respective destinations,” Abondo said. “Because of that, we have started sending two people to accompany a driver during delivery.”

He said the system requires the receiving institution to place an order to CMS who scrutinize and authorize the requisition.

“Sometimes goods are not recorded in official books,” he said. “and two people from both ends connive.”.

He said a pharmacist at Mzuzu Central Hospital is at large following revelations that he and that former employee, who is currently under police custody, destroyed documents so that they could siphon K500, 000 worth of drugs.

Abondo said two officials have the mandate to authorize delivery of goods to a particular hospital upon request. However, a third official had the authorization sign in absence of the two top officials.

The former employee, Abondo said, developed a habit of colluding with pharmacists in the absence of the two directors.

One day, in April of this year, the now-former employee conspired with a pharmacist at Mzuzu Central Hospital to bring an order that he was to sign immediately.

When the order was placed, Abondo said CMS official processed the consignment of goods and the pharmacist collected the drugs.

Unfortunately, the consignment did not reach Mzuzu Central Hospital. Both the employee and the pharmacist destroyed the documentation.

They were unable, however, to destroy the record of the consignment that was recorded at the gate.

A whistle blower informed the CMS's national office. Officials there started investigating the matter. Police arrested the employee after they discovered that someone diverted the consignments to other destinations.

Abondo emphasized that the government is trying all level best to curb the corrupt practices taking place at CMS. He said that the former employee's case is an example of corrupt practices that happened at the CMS in the past.

This, he said resulted, in the drug shortage in government hospitals and the need for reform.

In the past, he said, the institution operated without a strategic plan. Now the administration is in the final stages of drafting the strategic plan.

Stolen government drugs sold
in illegal underground market
By Mundango Nyirenda, Rex Chikoko, Arnold Mnelemba and Edith Mkwaila
There's a drug crisis in Malawi. No, not the illegal kinds of drugs. It's a drug shortage - a shortage of prescription medications at government hospitals and clinics.

There would be enough of a supply for everyone, that is, if staff members weren't stealing it.

Government employees are conspiring to steal the very drugs that poor Malawi patients should be getting for free. The drugs either end up for sale at private clinics or they end up for sale in market places in poor neighborhoods.

Either way, those least able to pay - the low income residents of Malawi - face the choice of lining the pockets of the corrupt or of risking death by going without essential medications.

At the age of 20, Eluby Tipoti is a guardian to her five siblings. Since the deaths of their parents and their elder sister, the six of them have constituted a complete family. They live in a two-bedroom, rented house in Blantyre's populous Ndirande Township.

Tipoti's mother and father died at Queen Elizabeth Central Hospital of tuberculosis and meningitis in 1996 and 2002 respectively. Her sister died shortly thereafter. She was only 15 years old when her father died and, at that time, she was in form two.

After the death of her father, Tipoti dropped out of school for lack of school fees. She was also left to assume the role of a parent to her late sister's two youngest children. The children are always sick, she says.

"Life has been hard for me and the little ones; it is actually a nightmare that I have to fend for five kids at my age,” Tipoti says. “My biggest challenge is to take care of the young children when they are sick. I can't find drugs at hospitals.”

She said early this year the two youngest children got sick and were weak.

She took them to a nearby government clinic, Ndirande Health Centre, but when they went there clinic officials told them that there were no drugs.

She says that her only alternative is to buy them on the streets.

“Vendors sell drugs at high prices I can not afford," she said.

The government medical drugs that are supposed to be free, indeed, are finding their way into private clinics and, even worse, into the hands of street vendors, Malawi Observer has learned.

Later Tipoli said she received assistance, in the form of drugs, from a neighbour who works at Queen Elizabeth Central Hospital as a labourer.

Even though she knew the man was not qualified in medicine, she says she accepted the medical help from him anyway. He was the only person available with medicine at a price she could afford.

“We paid K1,000 for the drugs,” she said.

Living in Blantyre, the commercial city, can be a nightmare for the poor. Too often, they do not have inexpensive access to safe drinking water, to basic health services or to nutritious food, and therefore, they are prone to catch most of the communicable diseases - diseases such as cholera, diarrhea and dysentery, health experts say.

John Karonga, 17, is a resident of Ndirande Township in the city of Blantyre, but hails from Mulanje District, 100 kilometers to the southeast. He earns a living selling strawberries.

Karonga is married and has three children, He says he makes about K135 as profit (less than US$1) per day and rents a grass thatched muddy house for K800.

The house is without electricity, so they and use paraffin as a source of energy. He says that that their lives are in danger. The biggest challenge in the city is accessing medicine from government hospitals, he says. The government clinics are experiencing drug shortages, but he cannot go to private clinics because the drugs there are too expensive.

“Sometimes we are told to buy medicine from pharmacies,” he said, “but with limited resources, it becomes a difficult process for a poor person like me access medical treatment - even at government referral hospitals.”

The problems affecting his nearby hospital range from lack of medicine because of distribution hiccups, inadequate resources and drug theft perpetrated by top hospital staff to poor selection and identification of much needed drugs.

Joseph Chingale is a resident of Zomba. He says it becomes difficult to access medication at the hospital because of shortage of essential drugs.

A nurse working at the hospital confirmed that it is true. She says that they have to tell some patients to purchase drugs from private clinics and commercial pharmacies because of drug shortage at the hospital. She, however, stressed the fact that, mostly, only the most needed drugs are available. For some serious ailments, getting medication can be a problem.


“Malaria drugs, pain killers and other drugs are readily available but if you talk of asthma, hypertension, diabetes and other diseases of that sort are difficult to find in hospitals,” she said.

She said some medical personnel get drugs from the hospitals and give them to their relatives. Unscrupulous medical staff steal medicine from the hospital pharmacies and sell them, she said.

“Some hospital staff steal the medicine from hospital pharmacies and sell the drugs to vendors because of greed,” she said.

A snap survey at one of the popular market in Zomba, Ndola, revealed that some vendors sell medical drugs without clear prescription. Some of the drugs have government sign “MG” or “GoM”.

Radolfo, a labourer at one government facility admitted to the Malawi Observer that he steals drugs from the government medical facility where he works. He agreed to talk on the condition of anonymity.

Radolfo is not his real name.

He says he cannot depend on only his job for his livelihood. When he gets off work at his government job, he goes to work as a drug dealer.

“I get drugs from where I work and sell them to my neighbors and some private clinics,” Radolfo said.

He says he has two main ways of siphoning drugs from the hospital - practically for free.

“I connive with guys from the pharmacy and stores who gives me the drugs,” he said. “After selling I give them their share of the money.”

Radolfo says facility security officers do not search him when he is leaving after knocking off. Everyday he gets small consignments of drugs in his bag, he said.

He said neighbors know that he sells drugs at a low price, hence neighbours always go to him to buy medicines. Nevertheless, he is not a qualified medical practitioner.

“I also sell the medicine to private clinics and vendors. They pay me upfront,” he said.

Radolfo said he provides drugs for different ailments including malaria, cough and even reproductive health services.

An official at Wazi Private Clinic in Ndirande says that many people simply prefer going to private clinics in the area.

Clinical officer Jeffrey Moto said his clinic offers treatment to about 60 patients every day. Many, he says, prefer to go to private clinics in the township because they are guaranteed of fast medical treatment.

Moto says the clinic offers general medical prescriptions and administration, reproductive health services, which includes pills distribution and removing Norplant.

“We buy our drugs from several pharmacies in town” he said.

He says they make about K30, 000 every day. The actual cost of drugs administered to patients in a day is about K5, 000.

Investigations by Malawi Observer reporters in Ndirande Township in Blantyre, and Area 23 market in Lilongwe revealed that some government medicines with government's label are available at open markets.

Reporters found a variety of drugs and medications available, including contraceptives, bacterium and pain killers.

For most of the drugs, it would be impossible to know if they are dangerous - that they may have come from packages that show expired dates. One package of birth control pills displayed the name of the United Stated manufacturer as well the manufacturer's control number.

When Malawi Observer reporters contacted the U.S. manufacturer, the company's vice president said that the particular control number was for a product that they no longer produce - even though the product name was that of their current product. It suggests that either someone outside the company is repackaging obsolete medications to make them appear to be a different medication or that the manufacturer is “dumping” outdated products into African markets. The company spokesperson would not provide further details. Malawi Observer reporters are hoping they will receive additional funding so that they may continue the investigation.