Keeping the medicines coming

I finished my first mission in the Central African Republic in March 2015. It was a great experience, and after a three month break: catching up with friends, family, good food and holidays, I felt ready to go again.

It has been just over a week since I arrived in Lulimba, a village in the South Kivu province of DRC. The setting is gently rolling hills, with a backdrop of forest covered mountains.

MSF support a hospital and a number of outlying health centres. Large proportions of the population do not have ready access to healthcare, and the burden of malaria and other infections is high.

My role as a pharmacist is to support the medical and logistical staff in managing the supply and use of medicines and medical supplies. I also work with the national staff in the projects to manage the storage and flow of medicines to patients, wards and clinics, and to keep accurate records of usage and stock levels.

With medicines being the primary intervention, the supply of reliable, quality medicine is crucial to MSF’s operations. In the western world, when a pharmacy runs out of a medicine, the supplier is contacted, and a same, or next-day delivery, is usual. Here, we order the majority of our supplies from Europe, three times a year.

So when it’s gone, it really is gone for quite some time.

Along the road. Photo by Barbara Pawulska in DRC

Along the road. © Barbara Pawulska in DRC

Our orders are based on an estimate of the number of patients we will treat, along with information about expected disease patterns.

The importance of prescribers sticking to prescribing guidelines – MSF protocols – really hits home under these circumstances. If antibiotics intended to treat meningitis, for example, are used to treat other conditions, they will run out before the four months are up.

Of course, predictions are not altogether reliable; populations move, levels of disease vary. In these sorts of settings, the only certainty is a lack of certainty.

The other side of the coin is overstock, too much of a particular medication in a project, and you risk it going out of date. We try to get it used, maybe in another project, another section of MSF or by offering it as a donation, if the expiry date is long enough, to another organization.

Expat life here is pretty comfortable, and we enjoy freedoms which were not possible in CAR.

We went out to eat in a local café one evening last week, having preordered the food, the day before. Edging in between huge, closely parked trucks, negotiating the jump over the wide roadside ditch, we reached the café. A few tables and chairs around the main draw of the place, a pool table.

After sitting down, a plastic washing up bowl, a large jug of water and liquid soap were brought to the table, and one by one, we washed our hands. Food was served. Grilled river fish, fufu and leaves in a sauce, all eaten with hands. Delicious. Afterwards, the hand washing ceremony is repeated.

I will stay here another few days before travelling overland to Baraka, the mission’s other project on the banks of Lake Tanganyika.