Lethal 'Cures' Plague Africa

Ivoirien police destroy confiscated fake drugs.
Abidjan police destroy 1.7 tons of fake drugs confiscated from quack doctors in the markets (Photo: Jean-Philippe Ksiazek/AFP-Getty Images).

In Lagos, they are called gbogbo n’ises, which means “they can cure all ailments with one drug.” In Abidjan, Côte d’Ivoire, and other parts of francophone Africa, they are known as pharmacies par terre (roadside pharmacies). They are referred to as “chemists” in Makola, Ghana’s biggest market, and they are very conspicuous as you arrive at the City Market in Nairobi. In Lomé, Togo, they are more than “pharmacists”; they are known as docteurs de rues (street doctors), because they go beyond selling drugs. They diagnose, prescribe, and even advise families to bring their patients to a given address if the symptoms persist. These “doctors” and “pharmacists” claim to cure such ailments as malaria, tuberculosis, sexual impotence, mental illness, infertility, and HIV/AIDS. In most cases, they prescribe one drug that, according to them, is capable of curing all those maladies.

They are everywhere in Africa. They have become a part of the typical African market and can even be seen on the streets and around government buildings, where they treat government workers. Some have perfected their deadly deal by going about with a van fitted with loudspeakers that blare out unverifiable claims, such as “Buy this drug, and you‘ll be free of all your diseases”; “I cured a mother and her child of AIDS with this tablet”; “Just one injection of this medicine, and you’ll never hear of sickle cell anemia again”; “This capsule will cure you of all your ailments—and if it doesn’t work, come back for a refund.” Unfortunately, thousands of patients won’t be getting a refund. Not because the “pharmacists” and “doctors” disappear—but rather because the patients do not live to tell their tales.

The drugs prescribed come in various forms: capsules, tablets, syrups, effervescents, drops, or powders in a sachet. Some of these drugs are very colorful, in liquid form, and need to be mixed. Patients are given different choices of combinations, and the more complicated the “concentration,” the faster the recovery.

All a patient needs is to describe his or her ailment, and the roadside doctors go to work prescribing drugs whose instructions they cannot read. They ask two or three questions, as a real doctor or pharmacist would do, and then prescribe and sell the needed drugs. Some of these merchants of death even have the audacity to take their patients’ temperatures, measure blood pressure, and use a stethoscope.

Vieille Camara is an unavoidable personality as one enters the rowdy Adjamé market in Abidjan, Côte d’Ivoire’s commercial capital. A colorful lady and a self-professed “respected pharmacist,” she shouts for patients from the loudspeaker of her weather-beaten van; she is always surrounded by scores of people. Though she’s illiterate, she knows the names of the drugs in English and can provide medicine for any kind of ailment. “I’ve been in this business for 20 years and nobody has come back to me to complain,” she boasts. Asked if she could confirm the source and the genuineness of her drugs, she quips rhetorically: “What has that got to do with me or my patients? All I’m interested in is doing my business and helping my poor patients.”

The majority of the drugs sold by these roadside pharmacists and doctors are counterfeit medicines masquerading as products from major pharmaceutical manufacturers—antibiotics, pain relievers, Viagra, antimalaria tablets, birth-control pills, etc. With the HIV/AIDS scourge and the inaccessibility of drugs to the average African, there is a great demand for the roadside pharmacists and doctors who are promising a cheap and efficient cure to the desperate.

In a session at the World Summit on Sustainable Development held in South Africa in August and September 2002, Harvey Bale, head of the International Federation of Pharmaceutical Manufacturers Associations, revealed the danger faced by sick people in many developing countries, especially in Africa.

“We don’t have [reliable] data, but we estimate that in Africa as a whole, 25 to 50 percent of the pharmaceutical market is counterfeit.” The worst-hit country is Nigeria, which accounts for 50 percent of the total sales of fake drugs.

Where do these drugs come from? Many West African countries such as Togo and Benin Republic point to Nigeria as the source, while Côte d’Ivoire and Burkina Faso accuse Ghana. Other alleged sources for the counterfeit drugs are South Asian countries, mainly Bangladesh, India, and Pakistan. Ironically, these Asian countries acknowledge the export of counterfeit drugs but accuse one another of doing it to tarnish the image of their respective pharmaceutical companies.

In a recent interview in Bangladesh’s independent newspaper New Nation, S.M. Shafiuzzaman, president of the Bangladesh Association of Pharmaceutical Industries, charged that huge quantities of spurious drugs made illegally in different parts of neighboring India are smuggled into Bangladesh every year. While Bangladeshis consume most of these drugs, the rest are exported to many African countries, thus damaging the reputation of Bangladesh’s mammoth pharmaceutical industry, which exports drugs to as many as 52 countries. Pakistan and India have accused one another of importing fake drugs to their countries to discourage African exporters, of whom the most important are Nigerians. Bale also accused India, China, and Russia of being major importers of fake drugs.

“It’s a growing business. Counterfeiting has become as profitable as illegal drugs,” he charged. Apart from Africa, where the fake drug importers have their stronghold, the drugs also enter Europe and America with immigrants arriving from the accused exporting nations. It is not difficult to buy some suspect antibiotic made in India from a shop at the Queen’s Market in East London. Poor patients in Africa fall for these drugs because of their cheap price. In Europe and America, some of the drugs are so well disguised that it might be difficult to tell the fake from the original.

What can be done about this deadly business? Bale suggests that the World Health Organization (WHO) should treat the fake drug market as a health hazard and involve all states, especially Third World countries.

WHO spokeswoman Daniela Bagozzi believes that “the problem is growing worldwide due to the dropping of trade barriers.” In a bid to fight this blossoming trade, WHO and other international agencies, such as Interpol, met in Hanoi, Vietnam, on Nov. 11-13, 2003, to tackle the fake drug problem in Asia.

Until a concerted international effort is undertaken to curb the spread of counterfeit drugs, however, one can only pray for the patients of Africa’s gbogbo n’ises, docteurs de rues, and pharmacies par terre.