For eight months Iqbal, a resident of Khost in southeast Afghanistan, dutifully took the medicine his doctor had prescribed him, but his condition did not improve, says a report by the Institute of War and Peace Reporting.
Finally, he travelled over the border to Peshawar in Pakistan and sought a second opinion. Doctors there diagnosed him with the same illness and recommended identical treatment.
“I told the doctors in Peshawar that the medicine they were giving me was the same as I’d been prescribed in Khost and which hadn’t made me recover,” Iqbal said. “When I took the [new] medicine until it was finished, I got better.”
After he returned to his Pakistani doctor and received a clean bill of health, he asked for an explanation.
“He told me that the diagnosis by the doctors in Afghanistan was correct, but the medicines were unsatisfactory,” he said.
Out-of-date or counterfeit medicines, often administered by under-trained doctors, are a serious risk to public health across Afghanistan. The problem is especially acute in provinces like Khost, where a common border with Pakistan provides rich opportunities for smuggling, including substandard pharmaceuticals.
Khost resident Mohammad Taib said that he had been to various doctors with the same common malady and had been diagnosed differently each time.
“Quite simply, we have neither doctors nor medicines,” he said. “They just play with people’s lives.”
Khost doctor Abdul Qader Sayar said it was not the skills of Afghan medics that were deficient, but the medicines available to them.
“We have doctors who have treated patients abroad, but when we give patients medicine here, they do not recover. The reason is that the medicines are inferior.”
Enayatullah, a doctor originally from Khost who is now studying for a dermatology specialisation in India, says that has been his experience, too.
“When I prescribe medicine for someone in India, they recover, but if I do the same in Khost, the patient doesn’t get better. The reason is substandard medicines, which has made people distrust domestic doctors,” he said.
IWPR says none of the Khost pharmacists whom patients and doctors accused of selling fake medicines would speak to them.
Illegal trade
According to the pharmacy office of the provincial health department, 40 to 50 percent of all medicines available in the province have been smuggled in from Pakistan.
Hedayatullah Hamidi, the acting director of public health in Khost, said attempts to combat the trade were being hampered by a lack of testing equipment.
“If we have the machine needed to check medicine quality, we will be able to prevent the smuggling and use of low-quality medicines to a large extent,” he said, adding that he had repeatedly asked for – and been promised – such a device, but yet to receive one.
Hamidi said the length of time the quality control process took was also a problem.
“When medicine reaches customs, the trader brings a sample to the public health directorate,” he explained. “The directorate sends the sample to Kabul for checking. The results come back from Kabul in a month. This costs the trader a lot, so no one wants to import medicine legally and they resort to smuggling.”
The cross-border trade is damaging legitimate importers and producers of medicines in Khost.
Sultan Mangal is a representative of the Khost branch of Pakistan’s ATCO Laboratory Ltd., one of about 20 pharmaceutical companies registered with local government.
He said that while his company paid tax and imported reputable products, they were undercut by fake medicines trafficked from North Waziristan, Bannu and Peshawar in Pakistan.
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