Lucky
I am driving to Lucky Pharmacy across the street from Liberia’s national hospital JFK, also referred to as “Just for Killing” Hospital. JFK receives over half of the nation’s health care budget and Liberia is a country with free access to health care, but everyone knows that JFK doctors charge patients. The national drug supply (NDS) is located on the JFK campus and free medicines that are to be sent in the hospital or to public hospitals throughout the country are rumored to be sold at Lucky for a profit by unidentified conspirators and go-betweens. Everyone seems to know this relationship but like the morass of things that contain no reason in this world, no one seems to do be able to do anything about it. Hell, President Ellen Sirleaf, who most regard as honest and progressive, lives down the street. The Presidents best friend is JFK’s primary administrator.
IRC "secret" warehouse which only carries NDS approved drugs
It’s a good name Lucky. Its non-NDS medicines are gathered from a hodgepodge of suppliers from around the world, some of questionable repute. I spoke with the Deputy Minister last week and she claimed that 40% of the drugs at Lucky did not meet therapeutic standards—sugar pills, placebos, Tylenol masked as antibiotics. So if you really need medicines in Liberia that are not direct from NDS or from your own suitcase, you are kind of stuck. You have to be lucky because the odds of the medicine you stick in your mouth being effective are only slightly better than the flip of a coin.
I am after two medicines: Mefloquine and regular insulin. The Mefloquine is for myself, prophylaxis for malaria, a disease that is the #3 killer in the world that leads to red blood cells bursting and in a worst case scenario an inflammatory response in the lungs or the brain. I am out of my U.S. supply. The insulin is for a patient named Sayla who is a newly diagnosed diabetic coming to see me later at JDJ, where I volunteer each Saturday. Sayla was sent home last week with only long acting insulin which helps but which also means that her body can’t adjust to immediate sugar loads following a meal or snack, bathing her organs unnaturally in sugar water which will slowly rot them. JDJ doesn’t have regular insulin because the NDS where JDJ is supposed to buy its medicines is out and IRC’s international order of regular insulin contained within a much larger order is delayed by stock outs from our main supplier in Europe and the slow trudge of a cargo boat.
Sayla at Princess' birthday party (upper left)
The Mefloquine costs me $10 dollars for six pills which I will take weekly. The regular insulin costs $25 for one hundred units, which should last Sayla a little more than a month. I few things strike me during the purchase. 1) this is as rational as gambling in Las Vegas where casinos advertise 90 cents back for every dollar you give. There is no guarantee that these medicines will work, let alone be safe 2) No, this is like cosmetic surgery. You know you shouldn’t be doing this but because of desperation you do it anyway (yes obliterate my liver spots!) (and replace them with scars that everyone can see!) 3) $35 dollars isn’t that much for life saving drugs but the average monthly salary in Liberia is $45 bucks 4) the world is arbitrary. If I didn’t purchase the insulin for Sayla, no one would, and Sayla would die.
Two weeks ago the team was going to send Salyla home without insulin, syringes, glucometer or testing strips. “Why did we save Sayla’s life if we are just going to kill her by sending her home without insulin?” I asked the team.
“We are physician assistants and nurses,” George said, “we do not kill patients. But we cannot buy insulin for every single patient.”
“I am not asking us to buy insulin for every patient,” I said, “I am asking us to buy insulin for this patient.”
“How will the family keep the insulin cool?” Marlay asked, “they do not have a refrigerator or electricity.”’
“I don’t know,” I said, “how about an arrangement with the local store who keeps the orange Fanta and Club beers cold. How about ice in a box. We can get creative.”
“It will be difficult,” said George.
“Doing the right thing is usually difficult,” I said.
“Word will get out,” Marlay said.
“Good, then let the word get out that JDJ provides the best care around and that we send our patients home with the tools to get better,” I said.
“Okay, you are the boss man”, George said
“We are the boss men and women,” I said, “we decide what we at this hospital do.”
Medicine supply and organization are a big deal in Liberia
The transaction at the Lucky counter goes down like a medium-risk drug deal. No prescriptions necessary. Items all displayed in cut out shelves lining the medium-sized dusty room. Room doesn’t smell bad, but not quite right either. Other customers/users are present and scattered, looking up at the walls as if they reading information off of a large airport flight arrival and departure board. They appear as if they want to make sure that they get the information on the board exactly right but the information is voluminous and tightly ordered. Most of the customers are casual but some look worried as if they may not reach their destination. Some squint.
“Rescue,” the people behind the counter say, almost in unison, as I walk through the door.
“What’s up,” I say, “You got Mefloquine and regular insulin?”
The products quickly appear in front of me. The Mefloquine from the wall. The insulin from a room in the back.
“The insulin was kept cold, right?” I ask, opening the box.
“Naturally,” the man says, “refrigerated but not frozen.”
“You sure these medicines work?” I ask
“They work,” the man says, “we only carry medicines that work.”
“Right,” I say.
The man behind the counter gives me a $5 discount because he “likes me”, knows I will be back and knows that I help run an organization that buys almost a million dollars of drugs a year. While the transaction goes down, a man next to me is being handed a variety of different eye drops-- one for red eyes, another an antibiotic, another for itchiness. The combination doesn’t make sense and I can’t help but intervene. In essence the man thinks that he has something in his right eye, but after looking, it appears that whatever was there is now gone. I tell the man that the object might have scratched his eye making it feel like something is in it still. I recommend that he flush his eye with a bottle of clean water at home and watch and wait for a day. If there is increasing redness in the eye or any pus development he can always come back for the antibiotic drop which costs $15, which I can tell from the crumbled singles on the counter in front of him that the man doesn’t have. He repeats the information and thanks me.
As the man leaves, I turn to the pharmacy manager, an amiable mellow Lebanese man standing at the other side of the room, “Sorry for hurting business,” I say.
“No problem,” the manager says, “we are here for the customers. We don’t want our customers to have medicines they don’t need. He can always come back. We are open 24 hours a day.”
“Cool,” I say.
Typical Monrovia traffic and rain seen
