Drugless in Pagak

Today, Duncan, Titus, Jaffar, and I went to the local Payam administrators to try to get them on board with the creation of the Village Health Committee.  They gave us a tentative go ahead and agreed to call all of the local Boma (village) chiefs together tomorrow so we can discuss the process of selecting a man and woman to represent each Boma in the committee.  We were, however, lectured at length about the lack of drugs at the Public Health Community Center (PHCC).  It seems that not only has there been a complete lack of drugs at the clinic, but also the staff have not been paid salary in some months.  The drug shortage is starting to reach a critical level and risks jeopardizing the programs we are working on.

Earlier, I went to the clinic with Jaffar to check up on a woman who was admitted yesterday with a severe case of cerebral malaria.  The problem is that the PHCC is at a total lack of drugs, including the quinine that is necessary to treat Malaria.  Cerebral malaria is what happens when malaria goes from bad to worse.  The parasite crosses the blood brain barrier and the infected individual will no longer respond to a strong dose of prophylaxis (which can only treat malaria while it is still in the bloodstream.  Without treatment it leads to coma and eventually death.  Despite the lack of quinine, someone in her family was able to buy a dose in the local market.

Jaffar and I went to the two small shops where drugs are sold to see if we could track down some quinine.  You need about four or five doses to make a decent recovery from such a severe case (Each dose contains six mini-doses that are administered intravenously).  Although the woman had received one, the chances are high that she would soon relapse into a severe case or, even worse, one that is quinine resistant.  The first chemist we went to was not only out of quinine, but also most antibiotics and other drugs that would be helpful in treating severe cases.  The second chemist had a small supply of quinine at about 60 Birr (about six bucks) a dose.  I really wanted to buy the woman a second dose, but with my Ethiopian currency supply dwindling, I came up about a dollar short.  Hopefully the woman's family can come up with enough cash for her to finish the treatment.

Malaria season is just kicking into high gear.  Last August, of the hundred or so cases at the clinic, seven people died.  This August, I am going to try to increase my ground time at the clinic and cover the Malaria season in video.

The other case was a young girl who was bitten by a snake.  Again, the lack of drugs means that she will not be able to receive the anti-venom she needs to make a reasonable recovery.  They started her on a course of antibiotics to prevent infection, but once necrosis sets in she will have to be sent to a better clinic, perhaps in Malakal (quite some distance from here).  

The drug situation is a tough one.  Even if we were to have a ready supply of drugs in Juba, like most other supplies, it is near impossible to get them up here.  A better solution would be to purchase them in Ethiopia and transport them overland by LandCruiser and quad bike.  Unfortunately, the government has a seemingly unofficial policy of "Ethiopian drugs are for the Ethiopians" and it is impossible to get a large quantity of drugs cleared by customs.  What needs to happen is a huge stock up of drugs at a central field depot where the clinics can make a long (but possible) LandCruiser trip to pick them up as needed.  Especially in anticipation of malaria season.  Unfortunately, given the realities on the ground and the difficulties of transport, the drug supply issue is one that will not be resolved anytime soon