In South Africa, drug shops provide a kind of health safety net

Yaguina Nesly waits outside a hut whose corrugated iron walls are smeared with green and white paint.

It is one of several unlicensed pharmacies in Bangui, the capital of the Central African Republic (CAR) — outlets for cheap medicines for the city’s many poor.

Informal pharmacists, known as “doctas”, thrive here, despite fears they dispense counterfeit drugs, offer faulty medical advice and promote antibiotic resistance.

“I always buy my medicine here, because at the hospital you can only get an appointment with luck,” explains Nesly, 23, her nine-month-old baby swaddled on her back.

“I prefer to come to my docta neighborhood. It’s faster and cheaper.”

Inside the makeshift structure, Stephen Liosso-Pivara-Bembe, 33, hands her stomach pills.

Dressed in a white coat and a stethoscope around his neck, Liosso-Pivara-Bembe says he started his medical studies but never finished because he had no more money .

He works seven days a week in the store, which is decorated with pictures of yellow pills and a sign in white letters that reads: “Health First.”

People in wealthier economies may sneer or be shocked that illicit pharmacies openly trade like this.

Central African Republic

Sophie RAMIS

But in impoverished CAR, doctas are widely valued for providing a rudimentary health safety net.

The landlocked country has been grappling with a decade-long civil conflict and ranks second among the world’s poorest countries on the UN’s Human Development Index of 189 nations.

It has only 0.1 doctors per 1,000 inhabitants, 30 or 40 times less than Western European countries, according to World Bank statistics.

About 70% of medical care is provided by humanitarian organizations – 2.7 million people, or about half of the population, need medical assistance, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). ‘UN.

There are no official figures on the number of doctas, but as an anecdotal guide, AFP counted 10 illegal pharmacies on a single main street in a run-down neighborhood.

Here, long lines of people form, especially in the evening.

In Bangui’s fifth arrondissement, Antoine Bissa, a 39-year-old nursing student, worked hard at a store called Biba Pharma.

He said he treated around 100 people a day “for injections and drugs”, working until 11 p.m. He said the business was the only source of income to support his four children.

Most of his clients have symptoms of malaria or fever or need pest control or first aid, Bissa said.

He said he offered free consultation and cheaper drugs compared to conventional outlets.

But “if they are seriously ill, we tell them to go to the hospital for intensive treatment,” Bissa said.

Drugs are distributed based on what patients can afford

Barbara STANDING

Among the clients waiting for a docta was Gilles Doui, a 35-year-old civil servant, who suffered from muscle pain.

“I have three children and I don’t earn enough to go to a (normal) pharmacy,” he said. “I’d rather buy a few pills than shell out the whole package.”

Liosso-Pivara-Bembe said, “We sell drugs based on what people can afford.”

Purchasing drugs from neighboring Cameroon and Congo, but also from France, has allowed him to cut costs, he said.

“For example, a box of Vogalene (an anti-nausea drug) costs 7,000 CFA ($11), but you can get it here for 5,000,” he said.

CAR’s pharmaceutical regulators are fighting a phenomenon that, for all its flaws, meets a desperate social need.

“We don’t work with mini-pharmacies,” said Romuald Ouefio, head of the pharmacy and traditional medicine department at the health ministry.

“They are in the informal sector and encourage the spread of lower quality, or counterfeit, drugs,” he said.

There have already been cases of antibiotic resistance through the incorrect use of drugs.

For many people in impoverished CAR, unlicensed pharmacists provide a crucial safety net for their health

Barbara STANDING

“In a few months we are going to have a meeting with the owners to prepare them to move on to other trades,” he said, describing it as a preliminary step before a “very firm crackdown”.

Jules Dawili, who runs a medical laboratory in Bangui, acknowledged that antibiotic resistance has become a concern due to drug abuse or over-the-counter sales.

He notably mentioned amoxicillin, used to treat bacterial infections, and doxycycline, for the preventive treatment of malaria.

Even so, Dawili said, he did not feel “100%” in favor of the crackdown.

“Some of them (unlicensed pharmacists) are competent,” he said. “The government could select these, train them and test them so they can help medical professionals.”

“If the government shuts down mini-pharmacies, it won’t do anything for people who can’t afford to buy” drugs from licensed outlets, said Nesly, the young mother. “A lot of people are going to die.”

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