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.
