Listening to charlatans

One morning, at the Repheka Clinic of Pernier, a young man with a urinary tract infection told me that he has taken a medication that he bought from a “marketing” seller. Those “marketing” sellers push medications and other health products in public transportation. It’s a great strategy to get an attentive audience. Stranded in traffic, people have no choice but listening to charlatans.

My patient was in a bus, on his way to a town outside of Port-au-Prince. After the first quarter of the one-hour drive, a man in his forties stood up, introduced himself to the passengers, and began talking about medications, which he pulled one by one as he presented them. After a thirty-minute talk, he invited people to buy his satisfaction-guarantee products.

Upon hearing that one of the meds was good for infections, my patient bought it and began using it the same day. But after three weeks, he had seen no improvement in his symptoms. “What’s its name?” I asked. He couldn’t remember. Then he pulled a bottle from his pocket and placed it in front of me. I picked up the bottle to read the label. Simvastatin. “Was the seal broken?” I wanted to make sure that the pills are really Simvastatin. “No, it was not broken,” he affirmed.

I told him that Simvastatin has nothing to do with infection. It lowers blood cholesterol.

I was not surprised by this incident. Many Haitians buy meds from street vendors or from “marketing” sellers in public transportation. There has been a shift in health-seeking behaviors. In the past, when people get sick, they go first to home-remedies. Then, if the symptoms persist, they’ll go see a physician (or a voodoo priest). Nowadays, first, people will buy some pills, usually Ampicillin or Amoxicillin for infections, Paracetamol or Alpalide for fever and pain, and then if that doesn’t work, they’ll go see a doctor.

With such self-medicating practice, the abuse of Tetracycline, Ampicillin, and Amoxicillin can increase the risk of germ resistance and development of superbugs, among other adverse effects and interactions. The abuse of pain medication can itself increase false diagnosis due to masking of symptoms.

There are laws in Haiti forbidding the illegal selling of medications. In fact, all institutions selling or manufacturing medications must register with the pharmacy department of the Ministry of Health. Still, medications are sold everywhere, and by anybody. The problem is not the absence of laws, but the lack of enforcement. So, until we have in the health budget enough money to hire health inspectors, and pay them decently to avoid bribery, we must expect this situation to worsen.