When There is no Medicine

By Ian Speers, Americares Africa and Middle East Programs Associate. Written when based in Liberia with Americares country team.

Imagine racing a sick or injured loved one in need of immediate care to a hospital or clinic. But when you carry them into the hospital, instead of finding a well-equipped and stocked emergency room, you’re met by the sight of bare equipment tables and supply shelves.

Shelves in health facility storerooms in Liberia, where medicine and supplies should sit are often completely empty, such as this shelf at the Liberian Government Hospital in Buchanan.

Knowledgeable and trained health workers may be there, but the most needed equipment, supplies and medicines are absent. This scenario may seem unthinkable and unrealistic to those who have access to adequate health insurance and live in countries categorized by the World Bank as high income.

For much of the world, however, including those in high income countries with little to no health insurance, the struggle to access medicine is all too familiar. Even if free medical care is available, without access to the proper medicines, equipment and supplies both at health facilities and for ongoing treatment, health will continue to fall beyond reach.

In Liberia, health workers and patients bear witness to this exact situation every day. With a severely underfunded government and subsequently resource-limited Ministry of Health, government health facilities can provide services to patients for free but have an unreliable and small percentage of the medicines and supplies needed to provide care.

Rev. Youjay Clinton, the pharmacist at the Liberian Government Hospital in Buchanan, is faced with this painful reality each day. Given the constraints of the Ministry of Health and the small amount of money that the hospital can allot to procure small amounts of basic medicine, he knows that “patients are at risk, because drugs and medical supplies are not available most of the time.”

As a result, Pharmacist Clinton explains that “for most of those who come to the hospital, we will have to give them prescriptions to buy the medicine, even though they will have access to health workers here.” In Liberia, when a patient is given a prescription instead of receiving the medicine free of charge from the health facility, the patient must purchase the medication themselves from a private pharmacy. However, in Liberia, where the United Nations Development Programme estimates more than 68% of the population lives below the international poverty line of $1.90 USD per day, even less than $1 USD of prescribed medicine can be entirely out of reach for patients.[1]

Requette, a dispenser at LGH, explains that she finds herself writing prescriptions for almost every order of medicine for patients, as the medicines needed are rarely at the hospital. On this day, only nine different medicines were available for patient prescriptions.

Most patients who receive prescriptions are unable to purchase them. Often, Pharmacist Clinton sees the same patients return to the hospital with the same unresolved condition. “Over a period of time, the condition often becomes complicated and can even lead to some of them dying,” he says.

The frequency with which patients must be referred to other health facilities for relatively basic care is another clear result of the lack of supplies and medicines. In the case of the Liberian Government Hospital, multiple patients each week must be rapidly transported by ambulance over two hours away to hospitals in the capital city of Monrovia, with the hope that the needed supplies will be available there, simply because the needed supplies are not available at the Liberian Government Hosptial.

This “becomes frustrating, because the doctors see their patient; they know they can handle the case; they know they’re able to save that life, but because there are no supplies, they have to refer the patients to Monrovia, and some of them [die] during that trip,” says Clinton.

Otto, an ambulance driver at the Liberian Government Hospital, often brings patients over two hours to Monrovia to receive care, as the needed supplies for their treatment are not available at Liberian Government.

Because of these alarming and vast challenges, Americares works to increase access to medicines and medical supplies in Liberia through the distribution of gift-in-kind donations from pharmaceutical and medical supply donors. From a donor’s initial product offer to the shipping, importation, warehousing, distribution and monitoring of those products, Americares and the Americares Liberia country office work to bring medicine and supplies to those who need it.

Americares Liberia partners with health facilities providing free services in both Grand Bassa and Montserrado counties, including the Liberian Government Hospital. “Prior to Americares coming, our patient load was much lower because it becomes frustrating to people to coming to the hospital every time and only receiving a prescription. So, they stop going to the hospital,” Say Clinton. “With the coming of Americares, though, people now come to the hospital, and the prescriptions are reduced and medical supplies are given to them.”

Americares staff delivering medical supplies to the Liberian Government Hospital, including IV tubing.

Without IV tubing, Pharmacist Clinton explains, patients are constantly in danger. “A lot of people who come to the hospital come to the emergency room, and you need to provide fluids or IV medication to most of them,” he says. “In the absence of IV tubing, these people are at risk because if you give someone a prescription to go on the road and get tubing, before they come back, that patient has expired.”

James (left), a dispenser at the Liberian Government Hospital, and Pharmacist Clinton (right), inspect and inventory a recent shipment of IV tubing from Americares.

In the past five months alone, Americares has donated more than 1,100 IV tubing sets to Liberian Government to ensure IV solutions and medications can be administered safely and quickly.

While the need for medicines and supplies remains large, Americares is proud to help improve health outcomes for patients and communities by increasing access to quality medicines and supplies through gift-in-kind donations to partner hospitals and clinics throughout Liberia.

[1] UNDP. Liberia — Human Development Indicators. Retrieved from http://hdr.undp.org/en/countries/profiles/LBR