By Ugoji Egbujo

The rot is deep. The health sector is a suppurating sore. Quackery is rife.  If there is regulation, it doesn’t catch rogues. In nearly every district in Lagos there are flourishing  fake clinics. It isn’t just auxiliary nurses masquerading full time as doctors.  There are people who have received no medical training  but who are  confidently running thriving hospitals. The unsuspecting public are not to blame.  Patients do not usually scrutinize doctors licenses and qualifications. This army of  counterfeit doctors  attend to light and grave cases  and  routinely evacuate products of unwanted  conception. The roadside patent medicine dealers have been around since the ages. They have been dangerously filling gaps left by a decrepit health system. They  play the roles of doctors, pharmacists and nurses, combined.  They are responsible for most of the avoidable deaths from illegal abortion.

But  most of these wolves run around as wolves.  They have no real  professional education. They are not scientists of any hue. They took no professional oaths. Their sins and crimes are grave. They  could be propelled by greed. But they have the exculpatory  benefit of some measurable ignorance.

The real trouble lies elsewhere, the wolves that come, heavily woolly, as sheep.

There is a fast growing pharmaceutical chain in Lagos.  It has posh outlets, in malls. The staff are evidently handpicked. They  speak in polished tones. The company must be intent on  building a big reputation.  It perhaps attests  to that  status by selling its drugs  at  prices higher than most other pharmacies. It has managed to position itself as a kind of  standard bearer.  And that is why  its unethical practices constitute a real danger to the health care system and the society.

It was found worthy,  selected to  train and groom  pharmacy  interns. But some of its  innocent interns have  given graphic descriptions of desperation, opportunism and ethical waywardness that have become institutional culture in the company

This company  has  a perverted understanding of professionalism. Its  pharmacists are always immaculately dressed. Physical hygiene of staff is good.  But  corporate ethical hygiene is more important in a health care service provider.  The  company’s  approach to  profit making is outstandingly  aggressive.

Pharmacies are business concerns. They must make profit. But even profits, especially in the health industry, must be decent. And the methods of engagement with patients and clients must meet ethical thresholds. A pharmacy is not a second-hand clothes stall. Patients should not be enticed to buy more.

This chain  claims reputation. But it routinely sells antibiotics to patients without doctors prescriptions.  It treats patients as customers. Every pharmacist  knows that antimicrobial resistance is one of the greatest threats to global health. But this pharmaceutical chain that is spreading around Lagos,  lets its  staff  sell antibiotics  as indiscriminately as the  itinerant  medicine dealers found in luxury buses.

Drugs are routinely sold in open markets in Nigeria. It was once hoped that strict regulation  and proper pharmacies will someday come and sit on all streets and  shut these markets. But this pharmacy chain dispenses drugs with the  same recklessness of open market drug dealers.  It  sells everything to everybody,  except  perhaps opioids and regular sedatives.  Those drugs have caused huge scandals recently. So the caution it exercises on  them  is  for  purely self preservation reasons and not for  professional or moral reasons. Otherwise  they can sell very large quantities of basically every other drug to single individuals.

This chain is a picture of the new get-rich-quick disease that has infected the health sector. Some doctors sell  false medical reports. Some have even sold death certificates. Politicians on corruption charges routinely buy doctors decisions  and  confuse judges. These evils are known. But a seemingly modern  pharmaceutical chain that trains interns,  is being run like a fast food joint.  And no one seems to know.

This company foists financial targets on innocent interns. They now spend the mandatory 12 months in the company praying and begging  patients to come and buy drugs.  A pharmacy shouldn’t have the  avaricious commercial attitude like  a Nigerian  bank. We condemned banks when they turned young girls into slaves who must go out and bring in money. We thought the  impossible targets and threats of sack handed to bank employees were immoral. But imagine such unconscionable exploitation in a pharmaceutical chain.

The  young bankers could at least  beg uncles and friends to give them deposits. That may not harm those family members. But a  pharmacy chain  that pushes interns to coax friends and  customers to buy more drugs imperils the health of the society. This pharmaceutical chain in Lagos  tells interns  to cajole customers, trick them if possible, into buying even superfluous drugs. Little wonder it sells without  doctors’ prescriptions.

The Alaba electronics merchants have few scruples. But they do not reward their apprentices when they successfully fool their customers. This chain gives bonuses to its pharmacists  and interns when they manage to convince patients to buy  certain excessively  priced superfluous formulations of routine supplements. Interns are rebuked for not being as  passionate as Yaba market traders who drag passersby  off the road and into their shops.

It will be easy to weed out the patent medicine dealers and their nefariousness.  But a modern pharmaceutical company that teaches its staff to usurp the role of doctors is the proverbial wolf in sheep’s clothing. This pharmaceutical chain teaches interns to clerk patients and attempt medical diagnoses. So, wonder no more why  they  dispense prescription drugs  without doctors prescriptions.

The roadside  patent medicine dealer does these same  things.  But  he does them  with some measure of  visible guilt,  some contrition. He  always looks  over his shoulders,  and he never leaves his clients with the impression that he got  any medical training. He  wouldn’t even deny that he is a  quack. But in this pharmaceutical chain, this criminal activity is perpetrated  with academic arrogance. They hold formal trainings and workshops.

Pharmacy is a wide scientific field. Noble pharmacists would not stray into medicine. They would not want to become  medical doctors without being properly trained. And they will not finagle people who stray into their pharmacies. But not this chain. This chain’s professionalism is hollow and opportunistic. They pretend to possess clinical knowledge and experience. They  teach young pharmacists how to dissemble, how to fool patients.

This chain is not alone. Some other chains have copied this atrocious model.

We all know times are hard. And corporate entities have taken to cutting all sorts of corners to survive. The Pharmacists Council of Nigeria has a job to do. It must acquaint itself with the culture  and commercial attitudes of the pharmacies it has selected to train interns.  It must not allow economic difficulties and  materialism to erode the ethical grounding internship should offer young pharmacists.

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