2 viewpoints on running a pharmacy

A little context:

The clinics I'm working in are funded by an english charity and a charge for each consultation. They are run by the charity "SIFT" on behalf of the local health authority. As such they are not duplicating other work and are a recognised part of the district's health service
The system seems to work. The two dollar charge is affordable to the majority of the community. The team know which of the patients are unable to pay and can waive the charge. The medicines are all dispensed free of charge.
The clinics funded by the health authority are, by comparison, completely free. They are well resourced with personnel but not with medicines. Many patients therefore have to pay high prices at local pharmacies for the medicines they need.
SO we have a better supply of medicines and cheaper overall for most patients. However there are still a lot commonly used medicines that we do not have, or have so little of that we could only treat a couple of patients for a month or two - not helpful for something like high blood pressure where treatment needs to continue for years. Its a horrible feeling as a doctor to make a diagnosis and not to be able to offer any treatment. We go throught this with cancers that cannot be treated or viruses that need not be treated. It is even harder to make a diagnosis, know that there is a good treatment but not have it available. This is a daily expereince here.

The Joys of being a pharmacist:

Each friday and saturday Dr sandra has a series of representatives from the pharmaceutical agencies visiting her. I like to think of these gentleman as her drug dealers. They have lists of which medicines they have available and what price. Sandra orders what she needs at the lowest prices as they become available, praying the different dealers off against each other.
And then there is the market in town. I like to think of this as the sweetie store. Its in the centre of the capital city's main market. It had to describe if you haven't seen large developing world market. Its one continuous construct of tin shacks built ajoining each other. Covering a couple of square kilometres, one can find absolutely everything. It is the centre of trade for most people in managua. Somewhere in this shopping jungle is a lady with a shack full of medicines. The market is a dangerous place and I was only allowed to some with sandra on the grounds that I brought no money, no valuables, no bag, and said as little as possible as the prices start to go up the more western and rich one looks. So I tagged along a couple of weeks ago.
Imagine being 8yrs old and being taken to a big sweetie store in town. Floor to ceiling with your favourite sweets that you have not seen in any of the corner shops and had almost forgotten what they tasted like. That was what I was feeling as looked round this medicine shack
I never thouhgt I would feel such affection for certain classes of medication. I guess it comes from having to give people a partially effective treatment, or one with many side effects, for want of having the "correct" treatments.
So we bought ourselves a nice little selection of our favourite medicines. I had a selection with which to run a half decent clinic in a certain prison you may have read about - if they would let me in; but that is a seperate story...

The Sadness of being a pharmacist.

The other side of procuring one's own medicines came a few days later.

On the island of ometepe, and in nicaragua generally, there is little in the way of refuse collection. A lot of household waste is therefore burnt instead.
I usually like fires, fascinating to watch and all that. This little fire was different. We'd been sorting through one of the clinic pharmacies, putting medicines in their correct places and checking their use by dates. The fire was made of the medicines we could no longer use because they were out of date. I'm sure every pharmacy in the owrld has to discard out of date medicines but I'd never done it before. It felt a little like burning books - simply wrong.
For those of you asking "why the wastage?", some will be unavoidable; one can never know exactly how much of any particular medicine is going to be needed in any given ammount of time. Some is because western aid agencies think it is useful to give large ammounts of medicines which have a few months to run on their use by dates to the third world. What seems a generous gift will inevitably be a large bonfire. Thirdly a more rigourous inventory of medicines including their use by dates may ensure they are dispensed in a systematic manner; ie those nearest their use by dates dispensed first. This may be a sizable task however.