Lamentations of being a drug inspector

SAMSON OLEMA is the sole drug inspector for three districts in West Nile; Arua, Koboko and Maracha Terego. SATURDAY VISION’S LYDIA NAMUBIRU followed him around for two days and discovered an interesting man and dedicated civil servant with an almost impossible job.

IT is Wednesday morning and three men crowd around an office desk picking on a heap of boiled groundnuts. “This is our breakfast,” chuckles Samson Olema. “Our women left us.”

Olema is quite a character. He is as hilarious as he is passionate about his job.  Two days ago on Monday, he gate-crashed a media workshop and gave an unsolicited but hilarious speech on the drug issues facing Arua, Koboko and Maracha Terego, the three districts where he works. In the short speech, the journalists learnt that he has enough problems to move a camel to tears, but his comic delivery and the absurdity of his situation only brought them tears of laughter. “The Government gave me only a motorcycle for my work,” he said. “But, you cannot impound drugs on a motorcycle!” As reporters imagined the lone inspector trying to haul drug criminals and their contraband across long stretches of rural roads on a motorcycle, he added, “By the way, the motorcycle broke down six months ago.”

For a person with Olema’s job, humour may be the best medicine. What with the frustrating circumstances of his job. His jurisdiction of three West Nile districts is awash with counterfeit drugs and criminal drug vendors. People go without needed medicines as drugs are stolen from Government health centres. Others suffer serious health problems caused by unsafe drugs obtained from unqualified and sometimes criminal vendors. Yet, drug inspectors like Olema are not given the sufficient resources needed to make much difference.

For instance, Olema is employed by Arua district as its sole drug inspector. “But the district has no budget for drug inspection,” he says. Through National Drug Authority (NDA), the Government gives him sh150,000 for fuel a month, but he says this is neither adequate nor regular.

He is not the only one complaining. At the drug inspectors annual general meeting held last week in Kampala, speaker after speaker highlighted the problem. “In Kalangala, for instance, the drug inspector has to travel from one island to another to inspect all 34 of them. That means hiring a boat, buying fuel for it and when you arrest someone, it even gets more complicated,” David Ekau regional inspector of the central region illustrates. Yet, the Kalangala drug inspector also receives sh150,000 a month.

“The Government gives us so little facilitation,” Olema charges.

Olema may be a loose canyon when it comes to speaking his mind, but he approaches his job and dismal circumstances with a realism that may even be unnerving. For instance, he says he despises corruption, but has on occasion paid journalists to get issues surrounding drugs covered. He is supposed to police drug merchants, but because he often is not facilitated, he sometimes asks them to pay his transport costs since he otherwise would not be able to inspect at all. “What do you do, sometimes I just have to make deals with the criminals.”

Poor funding is a problem that dogs even the NDA itself. “Of course, being a Government body, we are under-funded,” says Kate Kikule. The body does not receive direct funding from the Government, but instead has the mandate to use the revenue it generates.

Kikule says this revenue often is not enough. The motorcycles like Olema’s broken one were bought with a grant from the Danish embassy 10 years ago, but now as they break down, NDA cannot afford to buy new ones. “We are trying to replenish them but we cannot do it at once. We can only do it in phases. Recently we were lucky to get funding to replace three of them that went to districts with dire need like Kamwenge and Nakapiriprit,” Kikule admits. She adds that although the body recognises that sh150,000 a month is not enough facilitation for district drug inspectors, “at the moment sh150,000 is all that we can offer.”

Despite the frustrations, Olema somehow remains passionate about his job. He talks about impounding drugs, apprehending unqualified drug dispensers and securing arrest warrants for drug criminals as if they are conquests of war.

“Today I am going to take you to Koboko to see a witchdoctor,” he tells our reporter on their first day together.  “Can you imagine he has syringes and tablets in his shrine? I confiscated all his things and brought them to the DPC (District Police Commander). But I hear they were released to him.”

On his first day with our reporter, Olema has a bigger problem than the witchdoctor – no transport to take him to the field. Since his motorcycle has been broken for six months, he has to wait for his boss, the regional drug inspector to pick him up.

For the reporter, waiting with Olema is fun as he tells her bizarre stories about the drug problems in his area. Apparently, a condom distributor strangely in Adjumani instructed a couple to swallow condoms and the man in the couple died nine months after the event. In another area, he has an army major who is running a drug shop in his jurisdiction and flaunting all the rules in the book. The same major reportedly stole the regional hospital’s ultrasound scan machine. Olema describes drug shops that only exist on market days: “Sometimes you go to inspect a drug shop in a distant sub-county only to get there and realise it is not market day and so the drug shop is not there.”

On a more personal level, he is sometimes harassed by the drug consumers he is supposed to be helping. “The first time I went to that witchdoctor, I nearly got beaten,” he recalls. “People tell you, ‘He is our doctor’.” Even closing an illegal drug shop can be complicated. “Locals will say, ‘the Government health centres have no drugs. At least he can sell us some.’

For hours, Olema transport fails to show up and once again he wishes for his motorcycle. “Most times I inspect only drug shops I can walk to,” he laments. The sh150,000 monthly transport allowance he is entitled to has not come since September, he says.  “To be able to inspect [far off areas], I sometimes strike deals with the criminals. I travel to see those who don’t have licences and ask them to pay my transport back. In return, I only sell them the licences and do not arrest them as I’m supposed to,” he reveals. On this day, his boss finally picks him up at 2:30 pm (five hours after the time he meant to leave) for the inspection in Koboko district, 40 miles away.

For drug inspectors, their problems do not end at under-funding and lack of transport. Their workload is also huge. Olema estimates that he would need three months to reach all 35 sub-counties he is responsible for. He is not the only one with such a big area to police. The NDA itself employs only 32 inspectors. “That means we have one NDA drug inspector serving one million people. Of course, it is a constraint. At least, we should have one inspector for 10,000 people,” Kikule says. That means the body needs at least 3,000 inspectors, almost 10 times more that it currently has.

To try and reduce the service gap, NDA works with district paid inspectors like Olema but that too has its problems. “They do NDA work and also the district drug management work, like delivering vaccines for immunisation. It is a constraint because they are not always available to us,” Kikule laments.

More worrying, districts around the country are beginning to phase the likes of Olema off their pay rolls, according to NDA spokesperson, Fredrick Sekyana. This means that the problem of few drug inspectors is going to increase.

The lack of inspectors and poor funding for those available is indeed worrying because as Kikule says, “these are the Police that ensure that the drugs supplied to the public are safe and effective.” Drug inspection is a young practice in Uganda. The NDA was only established in 1993. Before that, Kikule says drugs used to be sold on the open market. “They were like these goods you see being hawked on the streets today.” This was dangerous because “drugs sold in unsuitable premises eventually deteriorate,” as her colleague Stephen Lutoti, eastern regional inspector points out. Today because of some inspection, Kikule celebrates that “drugs are being sold in proper inspected and approved premises.”

Another benefit of drug inspection is that drugs have become much safer over the years. “We collected 900 samples of drugs in the central region and tested them. We found that our drugs are quite safe these days,” Ekau, the drug inspector for central Uganda reveals.  

Kikule underlines the importance of drug inspection saying, “It improves our life by ensuring that when we walk into a pharmacy or drug shop with a prescription, we will buy drugs that will cure the flu or malaria and will not have any adverse effects.

However, with little funding, the drug inspectors work and ethics may be compromised. Kikule believes that the Government should fund the sector better. “Since it is a matter of public health concern, it is upon the Government to avail more funds for drug inspection.” She also calls for the training of more pharmacists. “We need more people with expertise in pharmacy to be able to ensure that drugs sold to the public are safe,” she says.

Today, however, with too few qualified persons to go around and too little funds to work with, drug inspectors are indeed working against the odds. On the second day our reporter spends with Olema, his transport problems compromise him and his work again. The inspector has heard of a nurse in Koboko who injected a 22-year old man with quinine two months earlier. The man, Emmanuel Andama, is now in Arua Hospital in pain and unable to move his left leg. Today, however, Olema cannot hike a ride with his boss as he has already gone to Nebbi district. He plans to take the 1:00pm bus to go investigate this case. But it turns out the bus won’t be leaving before 4:30pm. Olema manages to find an alternative. He squeezes into a salon car as the fourth passenger, a luxury for which he pays sh8,000, almost double the bus fare for the journey. Once in Koboko, he has to walk 5km looking for the suspect nurse and clinic. Eventually, after dark, he finds the clinic. Hurriedly he collects evidence for a later court case.

But now, having paid double for his journey to Koboko, he has only sh500 on his person. How is he going to return home? He tracks down the chairman of the area’s drug shop owners’ association and borrows money from him! Should he ever have issues with the association members? Well, that is a bridge to be crossed or jumped off another day.

WHAT A DRUG INSPECTOR DOES
 To inspect the stock of drugs in the shops to locate fake or expired ones and impound them.
 To collect drug samples, packing them properly and forwarding them to a Government lab for analysis.
 To collect copies of records, such as invoices to establish how the drugs got to the shop.
 To establish whether the shop has qualified drug dispensers and secure arrest warrants for the unqualified staff.
 To report to the Police, Ministry of Health and the National Drug Authority relative to the seizure, destruction or sale of fake, expired or smuggled drugs.
 To accompany Government officials during the seizure to identify the fake or expired drugs.
 To act as a witness for the government at trials involving any violation of the law on drugs.
 To do detective work, such as supervising shops of questionable repute, following up vehicles suspected of carrying fake, expired or contraband drugs.

Certified drug shops to save rural people
BY VISION REPORTER
WITH thousands of drug shops located around the country, they are the most widespread source of medicines for Ugandans especially in rural areas. Often times they have drugs even when the Government health facilities do not. However, drug inspectors often find that the dispensing staff in drug shops lack basic qualifications and training and often sell prescription-only medicines illegally. Amoxyl, for instance, is one prescription only drug that is being widely sold in Ugandan drug shops. This kind of inappropriate dispensing of medicines is resulting into drug resistance among their clients.

To address the issues with ordinary drug shops, the Ministry of Health and National Drug Authority last month launched the Accredited Drug Shop programme. Funded by the Bill and Melinda Gates Foundation, the programme aims at improving access to affordable, quality medicines and pharmaceutical services where few or no registered pharmacies exist. Under this programme, new ‘model’ drugs shops are opened up and put under the management of properly trained dispenser. Alternatively, existing ones are required to pull up their socks and meet certain standards.

In either case, the drug shop in question is given a logo indicating that it is accredited. In addition to this logo being proof that they meet high service standards, it will also show clients that the drug shop is authorised to sell some prescription-only drugs that they will not find in other drug shops. Ordinarily, a drug shop is only allowed to sell over-the-counter drugs, like Panadol, for which a client does not need prescription.

The two health bodies hope that the establishment of accredited drug shops will improve access to affordable and quality medicines to rural people. It is also expected to bring on board drug users as the first level drug inspector as they (drug shop clients) are expected to choose the accredited drug shops over the others. The programme is currently only in its pilot stage and is only being implemented in Kibaale district, but the health authorities expect to roll it out to the rest of rural Uganda.