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Home > English > Communiqués > Tons of inappropriate drugs in South East Asia
Tons of inappropriate drugs in South East Asia
 
Even before they left, they were nervous. They already knew what to expect in Banda Aceh. They were trying to
remember the Bosnia and Albania experiences and prepared psychologically not to give vent to their pain at the
sad spectacle of international humanitarian aid -that is generous, certainly- but in the rush to provide relief, the
same mistakes are systematically made and the “need to help” comes before the “real needs” of recipient
countries. Some may say “it is normal, we had to act fast”. "That is not normal” Pharmaciens Sans Frontières
replies, and wonders why governmental, intergovernmental and non-governmental humanitarian actors do not immediately meet in order to be effective and avoid penalizing the 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 it so difficult to communicate?And yet, the message from the main humanitarian NGOs was “no donation in kind, only cash donations!”. But
the report is painful: tons of medicines of all brands, from all countries, with package leaflets in languages
unknown to the medical staff and too short shelf lives are stockpiled in warehouses and also in houses. In the
city of Banda Aceh alone, a football field-size warehouse would not be sufficient to concentrate on a single site all
the donations brought by different people and organizations and then left there for they are not needed. Even emergency health kits arrived in too large numbers and are no longer appropriate to the situation. And
medicines continue to come in! The governments of the affected countries do not dare to refuse them for fear of
offending donors. It is difficult to say ”no” to someone who is convinced that you need him. Especially if you feel
that he needs you to need him. Little by little, however, they recover. Sri Lanka had already asked PSF Germany and PSF Switzerland to pass the message that they wish not to receive any more medicines. The health
authorities in Banda Aceh kindly ask us to do the same thing. Too kindly according to our assessment team who
already makes a mental calculation of the cost of the destruction and the number of staff that will be needed to
do it. There is already so much to do to clear away debris, destroy the medicines damaged by the tsunami and rebuild! It will take even longer as inappropriate donations will also have to be cleared away and destroyed.
There are, however, Guideline for Drug Donations. They were first issued in 1996 by the WHO following the
numerous problems caused by drug donations. They were completely ignored: www.who
.int/medicines/library/par/who-edm-par-1999-4/who-edm-par-99-4.shtmlBut the biggest question that Pharmaciens Sans Frontières has is "Why were tons of branded medicines shipped
to South-East Asia while that part of the world produces a large percentage of the generic medicines used in humanitarian operations?" The ignorance of small associations is not even a valid excuse: you should get
informed before you doing anything and not let the desire to help come before the interest of recipient countries.You should never forget that any donation in kind is likely to compete with the local economy and affect the
viability of small local industries and shops. People become unemployed and dependent upon charity. Emergency humanitarian aid, in its haste, rarely considers the social environment that it strongly destabilizes.
The arrival of thousands of humanitarian workers creates inflation, prices go up sharply and the population that has already been heavily affected cannot afford to pay such high prices: the population is dependent upon
humanitarian aid, and looses its dignity.Pharmaciens Sans Frontières Comité International was not sure that its intervention would be necessary. At the
association’s headquarters, the reasoning was as follows:- organizations specialized in first aid will supply kits to cover the first three months... and perhaps too many. - the funds promised by governments will help the countries to take a quick look at rebuilding the destroyed
networks.- the pharmaceutical companies in the area have the capacity to supply the required medicines according to the
needs.- there is no indication of a massive need for medicines, except in the event of a cholera epidemic due to a lack
of clean water. Emergency health kits should be adequate to cover the first needs- only the lack of specialized personnel could justify our intervention.The first PSF’s concern to protect the affected countries was to ensure that there would not be any uncontrolled
collection or export of medicines. The support from the ‘Ordre National des Pharmaciens’ (the French Council of
Pharmacists) that immediately alerted its network through its regional councils, has been invaluable. In Belgium and Switzerland, PSF associations also managed to stop collection and shipment of medicines.
The second concern was to give early notice to potential donors of medicines that most of the medicines used in
humanitarian aid programs are precisely produced there and that medicines should not be shipped from here. Apparently, this was not known or it had been forgotten...The first worrying sign came from Thailand as we received an email on 1st January. Thai pharmacists, who had
already been victims of inappropriate drugs donations in the past, were watching tons of medicines being brought in and were asking PSF for advice. The second sign came from the PSF team in Sri Lanka and the team that
prepared to leave for Indonesia had to rethink: the objective will not be to verify if they require PSF’s expertise
to rebuild. The first and most urgent challenge will be to be “garbage collectors” to minimize the side effects of irrational humanitarian aid and to prevent any possible public health risks.So, a first project was submitted on 24th January to provide support to the management of pharmaceuticals in
the Province of Aceh. In partnership with local health agents and the WHO, it focuses on the centralization, selection and safe storage of unusable donations, the supply of quality medicines and medical equipment, the
strengthening of the storage capacity of the pharmaceutical warehouse of Aceh Province and the distribution to district stores, hospitals and health centers which supply 5 millions people. PSF-CI ASIE DU SUD-EST |
