The Drug Shortage Continues

Yesterday, we met again at the PHCC to discuss the complete shortage of drugs.  The supply of the critical drugs like Quinine is no worse today than it was yesterday (Still nearly at 0), but tensions over it have been steadily increasing.  The clinic staff is anxious over the clinic's condition.  And rightfully so.  They've also been working without salary for quite some time now.  Last year, when the same issue came to a breaking point, one of our staff was arrested by the local police for not suppling the clinic with drugs.

I'm afraid, that this is where things are headed again.  That is, unless we get the drugs here very soon.  One of the community health mobilizers, a 20 year veteran of the war, likened the situation to sending soldiers into battle with no bullets.  It reminded him of the time when he was given only two bullets for his rifle before a large engagement, fired them off within the first few minutes and had to run away.  That's not something you want your operation compared too.  Another second problem is lights.  If a patient comes in at night--too bad.  Without a generator to supply electricity, the staff have to work by flashlight or tell the patient to return in the morning.  SC had provided the clinic with a solar powered lamp, but it has gone missing in action--likely stolen and sold in some market somewhere.  

The problem is a complex one.  It begs the question--what are the roles and responsibilities of NGO's in post-conflict countries?  Especially those that have long existed as a humanitarian emergency that required the direct distribution of aid.  Duncan raised an interesting point, that when John Garang signed the CPA in 2005, it signaled the end to most organizations relief operations in Sudan.  Many have packed up and left, but others like SC are switching their programming from relief to development.  Aid dependence is a legacy of that time that will continue to affect life far after the end of the conflict.  And that's why this drug problem is becoming so acute.  The bureaucratic foul-ups and transport issues that have prevented the drug distribution aside (and I assure you there have been many), the current problem highlights the increasing divergence of community expectations and the responsibilities of organizations as they view themselves.  Community ownership of NGO programming and aid dependence are competing values--you can't have both.  At the same time, with an infant government of Southern Sudann (GoSS), public goods are in short supply and organizations cannot entirely abandon certain relief efforts wholesale.  Although that was not the intention of the drug shortage at the clinic, it has functioned as such.  One day the clinic had drugs, the next day it didn't.

And yet, what happens if a shipment of drugs is able to get through in the next month?  What happens after the rush on drugs a month later when the clinic is again empty?  You are back to square one--and that seems to have been the case during the period when our staff was arrested over the shortage a year ago and the situation today.  Who is to say that won't be the situation again a year from now?  Whose responsibility is it ultimately in the long run to keep drugs stocked at the clinic.

We talked about our two-pronged approach.  On the one hand, we are trying to get the drugs here.  Some are sitting somewhere in the region, but apparently there is no way to get them here given the weather.  The roads are flooded.  The other is where the idea of a Village Health Committee comes in.  Curative medicine is critical.  A person becomes sick with a life threatening disease and they need drugs and treatment to recover.  Otherwise they die. However, so many of the diseases here are preventable.  Not entirely, but with better sanitation facilities, knowledge of the spread of disease, and basic precautions the rates of infection will decrease.  If you can involve community stakeholders to become directly engaged in managing and solving these issues than you have a program that is sustainable.  When NGO's eventually leave,or the drug supply again runs out again, the region will be less likely to plummet back into a health disaster.  The problem is, thats a hard place to get to.  

The drug supply issue is threatening to undercut the VHC program.  Why should individuals help us mobilize others to spread awareness of a clinic's services if the community can't receive treatment there?  The short answer goes back to the importance of shifting attitudes towards accepting and using good health practices.  This would continue to reduce of the burden on the curative side of managing endemic health problems and makes for a better, self-sufficient society.  Yet this is something that is, at its core, an exercise dependent upon trust-building.  Without resolving the drug issue expediently, this trust is going to be in limited supply.