Dr. Tilak S. Fernando

Health care in Sri Lanka has been telescoped, focussed and become a contemporaneous topic where the ‘ Yahapalanaya’ government has promised to allocate more money to develop the Health Care Services.

Supplementary to this subject, pharmacies and qualified pharmacists in Sri Lanka has equally become a current topic to discuss. According to Ministry spokesman attached to Health, Nutrition and Indigenous Medicine (news item), although there are four thousand pharmacies within the country there are only one thousand qualified pharmacists to cater for the public, which sounds alarming!

In order to prevent disease or reduce ill treatment to patients and to improve public health, mechanisms for evaluating and monitoring the safety of medicines in clinical use are vital. Equally, qualified pharmacists are expected to be professional in their duty, with the knowledge and expertise to provide convincing information on medicine they dispense with.

Sri Lankan Law

 In Sri Lanka, law specifically warrants all qualified Pharmacists to hold a professional certificate. Despite such laws, what seems to take place today is many qualified & registered pharmacists tend to display their licences by hanging those inside their pharmacy for the public to view and employ unqualified cashiers to serve medicine to the public.

It is mandatory to give clear details of the drug and potency on the receptacle when pharmacists hand over drugs to the public. In Sri Lanka such norms seem to override international procedures and drugs are simply placed into small envelopes (with only swallowing instructions written on the envelope). The reason for this being many tends to buy drugs in small quantifies rather than a full pack or a bottle full! The most disappointing or rather the dangerous factor, however, is that anyone wearing a white overall can stand behind a sales counter in a pharmacy and hand out anything to the public, even the patient does not have a prescription (mostly to their known customers)!

Such unorthodox procedures pose a problem to naive patients, as on the one hand they are unaware of what drugs they are supposed to gulp day in and out, and also poses the problem if and when they decide to consult different medical officers with such ‘unidentified’ drugs as the majority is not ware of what they have been consuming!

In Most cases the patient carries an exercise book with him/her where the doctor registers notes in it, but on the whole the average person depends on the pharmacist to write details properly –i.e. the name of the drug, its potency etc. along with ‘ how to take ‘ instructions, when drugs are purchased from the pharmacy. In Western countries the General (family) Practitioner maintains records of his/her patients and whenever a patient is referred to a specialist or to a hospital there is always interaction with the patient’s regular GP and the hospital concerned.

Another major problem the Sri Lankan public faces is the price discrepancy in drugs that tend to vary from pharmacy to pharmacy; the excuse given being that imported drugs from the West and USA are dearer than the Indian drugs!

Standardising of Drugs.

Wherever the drugs are mass-produced, the manufacturers need to conform to either British Pharmacopoeia, European Pharmacopeia or the USP Pharmacopoeia standards, and to do that their laboratories need to obtain reference standards from the British pharmacopoeia, European pharmacopoeia or USP pharmacopoeia to analyse and evaluate their new products to ensure that they conform to any one of those standards. Only then the drug manufacturer is permitted to print on their drug packages as BP, EP or USP.  In some of the drugs sold in Sri Lankan pharmacies there are drugs without this information at all, except the country of manufacture displayed. This postures another worrying factor to buy drugs for those who have  some basic knowledge about the system that operates in the drugs industry.

Press reports issued recently indicated that the Health, Nutrition and Indigenous Minister Dr. Rajitha Senaratne has instructed the health authorities to formulate rules and regulations to control the prices of new drugs.  In the past, Cosmetic Devices and Drugs Control Authority, out of a glut of complaints from the public against pharmacies, managed to raid countrywide imposing heavy fines on those who violated relevant regulations.

 PATIENTS’ RIGHT

 The difference between the West and Sri Lanka is that in the West patients have the right to open their mouth and enquire from the medical officer what drugs are being prescribed and for what as many believe that its their body, their life and they are entitled to know what are being asked to swallow! The medical officer on the other hand explains to his/her patients in detail about the prescribed drugs. Antibiotics are the last things on a Western doctor’s mind to prescribe to a patient whereas in Sri Lanka it seems to be the norm! Added to such misery patients have got into the habit of requesting antibiotics even for a nose cold or a small cut! So the doctors prescribe and pharmacies hand out willy-nilly

There does not seem to have a uniform law in Sri Lanka or it is not strictly implemented with regard to the issuance of drugs, its price, with or without a prescription. Recently a friend known to the writer had to go through a maze to find out about a cancer drug called Arimdex (1mg), which had a huge price difference, where the price of a prominent pharmacy in Colombo was so exorbitant where an average cancer patient could not afford!

 Despite such huge price differences in major pharmaceutical institutions in Sri Lanka the irony is why the lives of cancer patients have been made much harsher and added more pain and misery to their gloom by making such an important drug a rare commodity and sold at exorbitant prices! How many cancer patients among low-income groups can afford to buy such a drug? Are we, as a society, prepared to consign such patients into a death row labeling them as terminal patients with no hope at all?

 HEALTH INSPECTORS

 The major impediment for such abuses of health regulations is believed to be the inadequacy of Health Ministry Inspectors to monitor and raid pharmacies regularly in the absence of an effective programme rather than leaving it to the officials at the Consumers Association to pound on such law breakers.

 Cancer sufferers are evidently on the increase and this is an area for health authorities to look into with wide open eyes when they are bolstering the health regulations by amending the cosmetic Devices and Drugs Act 27 of 1980 imposing severe punishments of Rs. 100,000 or one year jail sentence or both for violators of health regulations.

Another vital point to raise would be the doctors in Sri Lanka have the same attitude towards patients. Ask any questions regarding the diagnosis and medication given, they frown! This is more adversarial as unlike pharmacists, many doctors have personal experience of how patients are treated in western countries.

What Sri Lanka needs is a strict Pharmacovigilance system similar to that of in the European Union to monitor the efficacy of medicine and  to take remedial action to reduce the risks and increase the benefits of medication.

Our society is changing and the expectations of our citizens are also changing. There is a need to ensure that we too have a system, which is robust but also transparent and effective.

tilaksfernando@gmail.com