Cross-posted from PHM-Exch
Dear Dr.David Legge, Dr. Neil, Dr. Shuftan, antibiotic resistance. We talk, we write from years but nothing is changing. The proposed remedy is the one: let's train doctors on how to prescribe better. I 'solemnly' declare that this is *not* enough, that this *has been done* already in the past(IMCI) with poor/nil results. Today, worldwide, half of treated children receive an antibiotic for their viral condition, either cough or diarrhea. I cannot demonstrate it scientifically, but 32 years of work in 8 countries should be enough to conclude so.
Pharmacies. They are all over, hundreds of them, unlicensed, not manned by a pharmacist. You enter, order any antibiotic, they give it to you, you pay and you use it as you like, once a day, twice, for 3 days.....whatever. In some countries 'pharmacies' are a table at the market where penicillin vials are kept under the sun and sold, usually to treat gonorrhea.
Now i ask to you : is it so difficult for a country to discipline the all matter? I do little business in Tanzania, I assure you that rules and regulations are in place, even if you opt to open a grocery. Why then drugs are so liberally, unresponsively,perfunctorily sold? could donors have an 'influence' on this matter? I think yes: if you ask me help in terms of drugs I should ask that you deal Correctly with them, am I wrong?
80%/20%. Children treated with any antibiotic should not exceed 20% of all attendances(WHO). Under any circumstances. Why then the usual percentage is 80% and more? Neil, you have been in Dar es Salaam, you should have visited a dispensary, any, public or private and record this percent. There are also scientific papers on it(Gwimile et All) on this aspect.
Quality control of service rendered in dispensaries never includes this datum: what is the percentage of children(and adults) that leave the clinic With an antibiotic?. Never seen, in all countries where I worked.
I ask to you: should a doctor be free to prescribe as much as he wants? just because he's has been graduated in the past?
Conflict of interest. Suppose that in our countries prescription and delivery of drugs do occur in the Same setting, i.e. behind the doctor office, how long it will last such a system before authorities declare that This is a conflict of interest? blatant, senseless, absurd conflict of interest. Then why this system is adopted in all poor countries where I worked? don't they/we see that in this way medicine becomes a mere commercial exercise, an easy way to cheat the poor and make them buy Whatever is more expensive and therefore lucrative? There is need to 'train and re-train ' doctors or instead to discipline the all system?
Inform the public. I also read about this 'fantasy'. The concept is: if the public is made aware of the risk of too many drugs they will mitigate their prescription(of the drugs). So let's train the customers. Sorry, this is a pure nonsense, cosmic nonsense.
Public in Africa as in Europe as in USA is one : I am sick, prescribe to me something to make me feel better, full point.
Tell him that he will heal with 2 bottles of fresh water a day and you'll close your ambulatory within one month.
Discipline in the all matter of drugs should come from *Political *decisions, *Political* rules/regulations. Drugs are poisons, too delicate to leave in the hands of irresponsible, untrained, unscrupulous people.
Any country in the world has the capacity, the political power to do so.
The will maybe is missing.....
Ciao from Dodoma.
Massimo
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Massimo Serventi
Pediatrician
Dodoma
Tanzania
mailto:massimoser20@gmail.com