Cipla Quality Chemicals and Government of Uganda Manufacture and Distribute Sub-standard Malaria Tablets

Bakampa Brian Baryaguma

bakampasenior@gmail.com; www.huntedthinker.blogspot.ug

Ndejje Health Centre IV is located in Uganda, Wakiso district, Makindye-Ssabagabo sub-county, Ndejje division, Zanta parish. It is a public health facility, owned by the Government of Uganda, responsible for offering health services to people of Makindye-Ssabagabo, and surrounding areas. Health Centre IVs are designed to work within five kilometers, serving a target population of 100,000 people, more especially in rural areas, providing 24 hours in-patient and emergency services. They are mainly public health facilities from where patients are assessed, diagnosed, stabilized, and are either treated or are referred to other health facilities for further treatment.

 A sign post of Ndejje Health Centre IV, at the facility’s premises.

On Tuesday, 2 October, 2018, at about 8:30 PM (East African time), I was feeling unwell: feverish, general body weakness, and lack of appetite. Judging from these symptoms, I automatically knew that it was malaria, because for many years, I suffered from it, and treated it.

Throughout my malarial history, two drugs cured me: Fansidar, and Coartem. For many years, Fansidar was the commonest, but it was later replaced with Coartem, of 24 tablets, on a chart-like cover, having a picture of a mosquito, and the head of a person. I call this the old Coartem. After the old Coartem, other versions like Lumartem, Artemether, Artefan, and other brands were introduced.

The old Coartem looked like this (though not quite it, because I don't see the mosquito here).

In my case, it is the old coartem that cured my malaria. All the other new brands didn’t work on me. Buying them was always a waste of money and time, because I wouldn’t heal. I had to go back and look for the old Coartem. Its scarcity from the market continued worsening rapidly, until a time when it could only be found in government health facilities.

So, when I fell ill on 2 October 2018, as usual, I went looking for the old Coartem in all nearby private health facilities, but I didn’t find it anywhere. Then I thought of going to Ndejje Health Centre IV, a government facility in my neighborhood.

  This is the facility’s driveway, and main compound. This photo was taken on Saturday, 13 October, 2018, at about 1:30 PM. The place looks deserted on weekends, and public holidays.

I walked to, and reached at the facility at about 9:15 PM. I had only passed by this facility once, sometime back, during the day, while familiarizing myself with the Ndejje, Zanta area. But on 2 October 2018 was my first time to enter its compound. I entered its half gate (yes, one part of the gate is not there, leaving a dilapidated stand-alone half), and followed the driveway, looking for the reception. The place looked deserted and was as quiet as a graveyard, since there was nobody around – not even a security guard! The lights were on, the doors on the lower section were closed, but most of the windows were open. I continued to the upper section, where the maternity ward is, looked around, but still there was no sign of anyone. Then it dawned on me that the place was actually closed. I hang around in bemusement and astonishment, wondering how such a big and important health centre could be closed, and completely unattended to, at this time. I worried for the security of the facility, and safety of the taxpayers’ properties there. After about 20 minutes of disappointment, I decided to leave, go back home, and try my luck the next day.

 This is the main gate. Half of it fell off, and is not there. It’s impossible to cordon off the facility.

On my way out, I saw two shop attendants, opposite the main gate. I decided to go and ask them about the working hours of this place, and why it was closed very early in the night. They told me that it is generally closed during the night and open during the day; so it would be better for me to come during the day, the next day. But they said that if I am very sick, I can go to the maternity section, where I may find some people to help me. They directed me to the upper end of the driveway. This was about 9:40 PM.

I went there, found the building open, entered, paced around the corridor looking for attendants, but I couldn’t see anyone. So, I called out, ‘hellooooo…, abeenoooo….’ Then, a lady came out from a small room nearby, and asked how she can help me. I said I was feeling unwell, and believed it is malaria. She advised me to come back early morning, the next day, at 9:00 AM, since the hospital section that handles sicknesses like mine is always closed in the night. I asked her whether I can get the old Coartem from this facility. She said they are in the store, and they are free of charge. I thanked her, and left.

The next day, Wednesday, 3 October, 2018, I came in the afternoon, at about 2:30 PM. I wasn’t able to come in the morning, as advised, because there was something I had to attend to urgently and get it out of the way, before starting treatment. In any case, that is a health facility that should be open for the greater part of the day – so I thought.

When I reached there, I saw a gentleman wearing a clinical white coat. I approached him, greeted him, told him my problem, and asked him to guide me on what to do. He told me to first buy an exercise book from the nearby shops. I asked him why I had to buy a whole exercise book. He explained that I just need a small 32 pages book, for the doctors or nurses to write in, as they processed and monitored my treatment and recovery progress. Then he showed me the reception desk, where an attendant would formally receive me, and advise me on where to go next. I thanked him, and went to buy an exercise book, from a small metallic kiosk, located within the hospital premises, near the main gate.

 It was the first time I bought, and actually held, this kind of book in a very long time; probably my last time was in early primary school, about 20+ years ago!

I took the book, and waited at the reception desk, near the main entrance. I waited for some time, but no one came to attend to me. There was a woman seated next to me, who had checked in earlier, and was waiting for her laboratory test results. I asked her where new patients report to. She pointed to the empty chair and table in front of us, saying that there should be someone there. After getting her results from a nearby office (room 5), she advised me to also enter, and talk to the doctor there. This was about 3:10 PM. I went in, and found a tall, slim, and dark young man, who was packing things in his bag. He was clearly preparing to go. I greeted him, and requested him to help me, since there was no one at reception. He agreed, sat in his chair, took my book, and asked me to tell him my problem. I told him how I was feeling, and added that I know it is malaria. He asked me whether I had tested myself to confirm it. I said I hadn’t tested from anywhere, but I just know myself. He took some notes, and told me that, ‘Here, we first conduct a blood test to confirm the disease.’ ‘That’s okay,’ I said. Then he directed me to look for the laboratory, in room 12. I thanked him, and left.

 This is the reception area, with its reception table and chair. The grey door, seen in the extreme left, is room 5, where I checked in, on arrival. Although the writing on the wall states, in clear capital letters that ,‘ALL SERVICES OFFERED HERE ARE FREE,’ I discovered that not all services are actually free, as I shall tell you shortly.

I found the laboratory at the lower end of the building. This was about 3:20 PM. I found there another young girl, also waiting for a blood test. I greeted her, sat on a bench, in the corridor, waiting for the lab attendant. After about 20 minutes, he came, opened and entered the lab, and then came out to pick our books, after about three minutes, before entering and locking himself inside again. After about five minutes, he came out, and called me in. He pointed at a chair, and told me to sit on it. He said that he has been told to test me for malaria and typhoid. He informed me that the malaria test is free, but typhoid test is for Shs 5,000. I had little money on me, which I planned to use for emergency in the following days of treatment, mainly for drinks and eats, especially when I lacked appetite. So, I requested him to leave out the typhoid test for now, since I was even sure that I don’t have typhoid, because I always endeavor to drink boiled water. He agreed, pricked my second left-hand finger, squeezed blood from it onto a small white glass, for testing purposes, covered my finger with cotton wool, and told me to wait outside. He then called the girl. At about 4:15 PM, the lab technician returned our books, and told us to go to room 5 (where I was first received) for further assistance.

 This is the main entrance building. The laboratory is at the extreme lower end of the building, near the white vehicle. In the middle, at the lower side of the verandah (with a blue inscription), is a waiting area for patients who are about to be attended to, especially after they have got their lab results. The reception is on the upper window, of the upper side of the verandah. Photo taken on Monday, 8 October, 2018, at 11:10 AM.

We waited at the reception, to be called in. After a while, a nurse collected our books and took them inside. I was called in shortly. I found in an attendant who, as soon as I opened the door, asked me, ‘Ssebo, don’t you have a mosquito net?’ I smiled, and said that, ‘I have it.’ He offered me a seat in front of him. ‘You have malaria,’ he said. He scribbled some notes in my book, which I understood to be medicine prescription ‘Wait outside, I am coming,’ he added. I learnt later that his name is Wasajja. He was a nice, and jolly guy.

After seeing the other young girl, Mr. Wasajja came out, rushed to the store, picked a register book in which to record our details, got various drugs, found us at the reception, and wrote on the medicine dosage schedules (like 2x3, 1x3). He recommended that I swallow the new versions of Coartem. I realized that he brought Lumartem tablets, but had picked very many of them, which I brought to his attention. I knew that they were very many because I am aware that being an adult, I need 24 tablets only, for three days. Mr. Wasajja told me to pick what is enough for me, as he continued writing in the register book. He kept telling us repeatedly that it is late, but he has helped us to get the medicine. He was basically saying that he was doing us a favor of serving us late. I thanked him for his sacrifice. Actually, since he was rushing to leave, at first he brought and wrote in a wrong register book; but he crossed out later on, after realizing his mistake. Then he went back, brought the right book, and recorded afresh. ‘Do you see how you have caused me to make a mistake?’ he asked us in Luganda. We just kept quiet, smiling sheepishly. Probably he was just being funny and naughty, but not really meaning to blame us for his own mistake, in which we played no part at all.

 This was my prescription, including Lumartem tablets, cipro, panadol pain killers, and others. I thank the Government of Uganda for availing the drugs in public health facilities.

I told Mr. Wasajja that only the old Coartem can cure me of malaria. The new brands like Lumartem do not heal me. I requested him to give me the old Coartem, if it is there. He informed me that the old Coartem is not in stock, because government no longer imports it, since we now have a company (Cipla Quality Chemical Industries Ltd, which is commonly known as Quality Chemicals) that manufactures malaria drugs in Uganda. He advised me, however, that I should swallow the available tablets, and if they don’t cure me as I say, then I come back and get injections. He assured me that the process would be quick, and not hectic. I thanked him again, and left, at about 4:30 PM. I swallowed the tablets as instructed, from the first to the last, although I knew that it would be a waste of time, since they don’t cure me. They only give me temporary relief; and I badly needed that now.

During my medication, my brother visited me, and we discussed the fact that I was swallowing tablets, but without hope of healing. We were concerned that we have poor quality medicine on the market. Then he got one of the Lumartem packs, and inspected it. To our surprise, the malaria medicine manufactured by Quality Chemicals is meant to be given to people weighing between 15 kilograms to less than 25 kilograms. This basically means that it should be given to teenagers, but not adults (like me, weighing 68 kilograms). Probably this is the reason why it doesn’t cure me. Although, I am not a medical practitioner, I think swallowing low grade medicine is very dangerous for people’s health, because it causes drug resistance, eventually leading to death from the very disease intended to be prevented. I call upon Parliament, and Ministry of Health to investigate, and solve this problem, in order to save lives. The Government of Uganda shouldn’t condone this absurdity, by distributing substandard malaria medicine.

 Judging from the weight bracket indicated on this pack, this medicine should be given to young boys and girls. It is not meant for adults.

After three days of taking medicine, I realized that I had been given way too many tablets, in all the other categories I was given. So, I learnt that there is a lot of wastage in such public facilities, and this is dangerous for many reasons: for instance, one, it is obviously a waste of public resources; and two, some patients may end up taking overdose, thinking that all tablets must be swallowed. Anyway, since medicine is not food to be shared with others, I safely disposed of the excess tablets, by flashing them in the toilet, and threw away their polythene covers in a dustbin.

I finished swallowing my medication on Saturday, 6 October, 2018, in the morning. The truth is that I wasn’t cured. I still felt ill, and weak. So, the following day, Sunday, 7 October, 2018, I went back to Ndejje Health Centre IV, for follow up. Remember that Mr. Wasajja told me to go back for checkup, after finishing my dose, and that if malaria is detected again, then I would be put on higher treatment of injections. I went in the afternoon, at about 1:45 PM. I found the place deserted. It was empty, without anyone in the compound. But the entrance to the reception was open. So, I went to see who was there. I found three ladies seated and chatting in a nearby counter. I greeted them, and told them my story. One of them said they don’t work on issues like mine on weekends. She advised me to come back the next day; Monday, 8 October, 2018, at 9:00 AM. I thanked her and left.

On Monday, I went there early; by 9:30 AM, I was there, ready to have the blood test for malaria. I asked an attendant whether I also have to go through the process of checking-in again. She told me that I don’t; I should go straight to the laboratory, and wait to be called upon. So, I went there. I found there many people already waiting, sitting on a bench in the corridor. I joined them. Many others came, and soon there was no more space on the bench. Many remained standing. Several people kept on entering and leaving the laboratory, without saying anything to us. Soon there was growing discontent and murmurs of discomfort among patients. There was drama when a dumb man, who had allegedly fallen from a true, kept shouting, objecting to women who wanted to jump the line. His noises were funny, and amusing to many present.

The lab attendants began work late; at about 10:45 AM. My turn came, and I entered. Unlike on my last visit when there were only two people, this time I found many attendants in the lab. I gave my book to the lab supervisor, who read through, and asked me what the matter was. I told him that I had come to have a confirmatory test, to see if malaria got cured. He wrote something in the book, and told his assistant to take my blood sample. The book stayed with them, and I was told to wait outside, in the outpatients’ waiting shade. That’s the procedure for all patients.

 The out-patients waiting shade.

I stood at the verandah of the reception area, gazing at the high number of people who had come for treatment. I was also watching and studying the general environment in and around the hospital area. Then a lady employee came, and stood next to me, as if pondering her next move. I asked her whether this place works on Sundays. She said that doctors here don’t work on weekends and public holidays. She continued on her work, and soon after I joined others in the waiting shade, where I found the other man, who could not speak. We connected well, and became “friends,” albeit short lived. I think it’s because I welcomed and accepted him, while others chose to avoid him. But because he couldn’t speak, none of us knew his name. After about 40 minutes, a female attendant came to the shade with a bunch of books, called out names, and told them to follow. 10 minutes later, a male attendant came, also read out names, which included mine and the dumb man, and asked us to follow him. Some (including the dumb man) remained to be worked upon by someone at the reception desk, while I was referred to room 5.

In room 5, I found the other young, slender attendant who received me the first time I came (henceforth, I shall call him ‘the young slender doctor’). He told me that I have malaria. I agreed and explained to him that I was coming for the injections, after the tablets didn’t cure me of malaria. I asked him if I could get medicine for malaria injections in stock. He said, ‘We shall get it.’ He told me to wait outside, promising to call me later. He called in other patients that he had to see, and when they were over, I saw him move out, to the store.

He went there a couple of times, and finally called me in. I found him standing, and in a hardly audible voice, he asked me, in Luganda, ‘Do you have some money?’ I said I hadn’t heard. ‘Do you have some money? he repeated, more audibly. ‘Money for what?’ I asked. ‘We need money to get the medicine,’ he said. ‘How much?’ I asked. ‘20,000,’ he said. ‘To be honest with you, I have only 10,000. Can we get the medicine?’ I asked. He nodded his head, and said, ‘We shall get it.’ ‘Thank you,’ I said. ‘Bring it,’ he said. I got the money from my wallet, and gave it to him. He pulled small bottles and a syringe from a pocket on his white clinical coat, and asked me to follow him. We moved around, looking for an empty room, with no people, from which to administer the injection, but didn’t find any. Finally, he settled for a treatment room, where there were other colleagues of his, and their patients. I understood later that he didn’t want his workmates to know that he got money from me.

In the treatment room, he mixed the drugs, and sucked them into a syringe, ready to inject me. Thereafter, he got a cannula (sic), and tried to fix it in a vein on my left hand, but he failed to find one. He kept twisting the cannula needle in my hand, looking for a vein, but without success. It was painful, and soon my hand started bleeding and swelling seriously. Then he pulled it out, and asked me to give him my right hand.

 My bleeding, and swollen left hand. I still feel pain, probably because the bones were hurt with the cannula needle.

One of the nurses in the room saw that the young slender doctor was struggling, and failing to find a vein in my hand; so, she offered to help him locate it, on my right hand. She found it quickly, and with admirable ease. After ensuring that the cannula was well placed in the vein, the nurse started fixing it firmly on my hand, using a bandage.

 My bandaged right hand, soon after receiving my first injection. The bandage stayed on, for the two days of treatment.

After placing the cannula, the young slender doctor injected the medicine in me slowly, through the upper part of the cannula (the blue part). This was about 12 noon. I asked him what medicine it is. He told me that it was Artesunate (commonly abbreviated as Artesun). He explained to me that a dose is of three injections, administered in three phases, for three days. In other words, one injection every day, for three days. Since the next day (Tuesday, 9 October, 2018) was a public holiday (Independence Day), the young slender doctor told me that he wouldn’t be available. So, he gave me medicine for the following day, and advised me to find a health Centre from where it could be injected in me. He told me that it should be administered after 24 hours (one day).

But another attendant, known as Ukasha, after castigating him for being slow in treating patients, corrected him, saying that it should be administered after 12 hours, meaning that I was to receive the next injection at midnight – not midday, of the next day. Wow! I was about to suffer a case of wrong prescription, in terms of time, but Mr. Ukasha’s intervention saved me. As I received the injection, there was some discussion in the room, during which Mr. Ukasha, looking at me straight in the eyes, complained, in Luganda, that, ‘The problem is that our patients don’t part with anything.’ Meaning that their patients don’t give them any money (bribes); but the young slender doctor assured him that for me, I give something.

 This is the medicine given to me, for second dose, to be had at midnight, on Independence Day. I thank the Government of Uganda for availing the medicine in public health facilities.

 This is the medicine given to me, for second dose, to be had at midnight, on Independence Day. I thank the Government of Uganda for availing the medicine in public health facilities.

At midnight, I went to a friend of mine, a health worker, and requested him to mix the medicine, and inject it in me. He did. Then I went back to my home, for rest, and get ready for the last dose, at midday, of the next day, Wednesday, 10 October, 2018.

By 11:30 AM, of Wednesday, 10 October, 2018, I was at the health centre to receive my last injection. By this time I was feeling much better – almost cured, which reminded me of the old Coartem days, when I would be feeling well after the first two days of swallowing tablets. I found Mr. Ukasha there, in the treatment room. He told me to wait outside, so that he first finishes treating the patients inside. After about 10 minutes, he called me in, and told me that the young slender doctor told him that I still have some money of his (Shs 15,000) so I should give it to him (Mr. Ukasha). I said that I cleared the young slender doctor, so there was no debt. Mr. Ukasha said that we should call the young slender doctor to confirm this. He said that he wasn’t sure of the young slender doctor’s number; so, he gave me about four numbers to call, but they all turned out to be of other women. It was now about 10 minutes past midday, because he kept moving in and out, giving me different numbers to call. Finally, he said that it was getting late; so, I should give him the money, and he gives me the medicine. I said I could only afford Shs 5,000. He agreed, I gave him the money, and he administered the injection. Then, he removed the bandage, and cannula from my hand. He gave me another dose of Lumartem tablets to swallow, starting the next day – Thursday, 11 October, 2018. He also gave me excess tablets, just like Mr. Wasajja had done earlier. When I asked about this, he told me to count and pick tablets enough for me. I thanked him for giving me the medicine, for treating me, and left.

 The second dose of Lumartem tablets, after injections. I thank the Government of Uganda for availing the drugs in public health facilities.

There was a woman with a sick boy child, who was also receiving injections, for a sickness I didn’t know. She got a Shs 2,000 note, gave it to Mr. Ukasha, and told him to remove Shs 1,000. Mr. Ukasha asked her why he shouldn’t take it all. She said the other Shs 1,000 was for transport. He removed his share, and gave her change. That’s how seriously corrupt some of our public officials are: they will extort money from our poor people up to the maximum.

As we conclude this story, it is my pleasure to say that I feel fully healed of malaria, after getting the Artesunate medication. I thank the staff of Ndejje Health Centre IV for treating me. Once again, I thank the Government of Uganda and donor partners for availing the medicine in public health facilities. I realize that it seems I carried malaria in my body for many years, because I used to be constantly weak, fatigued, and sleepy, before I got this medication; I even had an enduring pain in my left knee, after I was pushed down by a mentally deranged woman neighbor of mine, in July 2018. After the medication, I am energetic, alert for most of the day, and the pain in the knee is going away. Malaria is a very terrible disease!

 The adolescent clinic at the health centre runs on a time schedule like that of a day care school. Unfortunately, virtually the whole facility runs a similar schedule now. A person can easily die from there, outside the indicated working hours.

During my last visit, there were women patients who were complaining that female attendants at the facility are harsh, and rude. That their work ethics are so poor that usually they are too busy talking and chatting on their phones to attend to patients. That particularly at the dispensary window, sick and ailing patients stand in pain, waiting for mean, showy, and insensitive nurses to attend to them, like giving them drugs. I call upon the responsible authorities in Wakiso district, and the central government to intervene and solve this problem.