Bulletin of the World Health Organization

Tiim

RP Shankara

Burkina Faso is a small, impoverished country in west Africa with a health infrastructure that is less than adequate. As is the case in most developing countries, the improper and inappropriate use of medicines is a major problem. Costly medications, improper use of prescription and nonprescription drugs, misuse of advertised brand-name medicines and use of inadequate and incomplete courses of medication are among the problems that Burkina Faso faces.

“Tiim” is a documentary film that deals with the problem of street-sold medicines in Burkina Faso. It explores the attitudes of providers and consumers of street medicines in the country’s Ouahigouya region, where street sales of medicines are common.

One of the main characters in the film is Kariim Campaori, a street vendor who carries his medicine bag containing paracetamol, ibuprofen, chloroquine, iron, vitamins and other drugs around the villages to peddle his wares. He is uneducated, like the majority of street vendors in Burkina Faso, and his knowledge of his wares is limited to information shown in pictorial representations on the drug packaging. He sells medicines for both people and animals. As the medicines are expensive, a complete course is too costly for most customers and often he sells only one or two tablets. The same medicines are used for both children and adults, with paediatric doses obtained by subdividing those for adults.

Later in the film, two farmers are interviewed. One states that he used to take street medicines, while the other is addicted to a stimulant pill called “14s”. It is claimed that this and another pill called “bleu-bleu” help people to work harder, neglecting even their needs for food and water. As shown in the film, however, after a certain period of time the stimulant effects of these drugs wear off and their adverse effects appear.

A former vendor of street medicines who works as a cobbler is also interviewed. He reports that vendors sometimes hand out medications for free to retain their clientele. They also commonly self-medicate themselves and become addicted to the drugs they sell.

The film then highlights an initiative to introduce generic medicines into the community. Covered in detail are some of the advantages that generic medicines have over brand-name products. A medication’s life-cycle from a newly introduced innovator brand with patent protection to patent expiration and the manufacture of generic equivalents is discussed. Many of the problems posed by street medicines, including the question of whether the sellers of street medicines have the necessary training and expertise, are covered. A community clinic run by a trained pharmacist is shown; the generic drugs that it stocks are properly stored and neatly arranged. These generics can be bought for much less than their branded counterparts and are supplied with proper directions for use, unlike most street medicines. Because the generics are cheaper, it may be easier for patients to complete the required course of treatment.

Many of the problems covered in the documentary are prevalent in other areas of the world where illiteracy and poverty are common. Although street vendors of medicines may not be common on a global scale, in many other settings drugs may be available over the counter without a prescription. Often, complete courses of medication are not purchased, or they are stopped once the patient starts feeling better.

The documentary is very well produced and the backing music by Badema sets the mood. It will be useful for training medical, pharmacy, nursing and other health sciences students in the more rational use of medicines. ■


Affiliations

  • Department of Pharmacology, Manipal College of Medical Sciences, PO Box 155, Deep Heights, Pokhara, Nepal.
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