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Tue, Sep

File image November 2017 - FDA arrests fake drug peddlers at Madina.

Thoughts From Afar
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However, it will also be disingenuous if we threw our hands in the air and allowed the problem to fester like we have done for the last sixty plus years. The fact is, drug peddling is a killer and a curse rather than a lifeline to many in our society, ...
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Malcolm Gladwell in Blink argues, “The key to good decision making is not knowledge. It is understanding. We are swimming in the former. We are desperately lacking in the latter.”

I have pondered over this statement for a while as I tried to get my head around our failure to deal with the menace of drug peddling. Whilst at it, I have processed all the usual excuses that have been churned out over the years to explain away our failure. Amongst them is a lack of healthcare professionals (doctors, nurses, pharmacist etc.), poor regulatory frameworks on the part of institutions like the Food and Drugs Authority (FDA) and Pharmacy Council, lack of health facilities especially in the hinterlands and illiteracy just to name a few. As I have gone through the excuses, I have not lost sight of how plausible every single one is. With a doctor to patient ratio of 1: 9030, a pharmacist to patient ratio of 1:13,500 and a nurse to patient ratio of 1:959 one cannot discount these excuses. Unfortunately, these statistics are not going to improve to any appreciable extent in the next decade even if we undertook mass health professional training with no attrition of the current personnel. 

However, it will also be disingenuous if we threw our hands in the air and allowed the problem to fester like we have done for the last sixty plus years. The fact is, drug peddling is a killer and a curse rather than a lifeline to many in our society, who turn to it in times of need. It delays the need for quick interventions by qualified health professionals and complicates health conditions whilst worsening treatment outcomes when eventually appropriate healthcare is obtained. Many of us are privy to instances where people have sadly lost their lives or narrowly escaped death having relied on inappropriate self-medication, initiated by quack doctors and drug peddlers.

Clearly, we have enough knowledge about the problem and the risks thereof but till date, we seem to have lacked the understanding to enable us to deal with it effectively. Since independence, we have believed that the best way to handle this menace is through enforcement of the law and regulation of our medicines supply chain. However, we are all testament to the fact that these illegal hawkers have gotten bolder and are more visible than they were even a decade ago. They have gotten bullish too and even verbally attack anyone, who attempts to confront them, especially on public transport. In this behaviour, they have often been supported by passengers who have been quick to attest to the efficacy of their illicit medicines. If anyone wanted evidence that our approach has failed, the proliferation of tramadol and other opioids on our streets and the wanton abuse that we have seen must surely be enough. If it isn’t, the ease with which antibiotics are obtained from illicit peddlers with little knowledge about their use could help.

Why therefore have we continued with this approach even when it has proven to be ineffective? The answer lies in our social structure and our approach to problem-solving. To start with, we are a power distant society. Throughout our history, we have thrived on status to the point that it has become farcical. The extent to which people crave for honorary titles just to boost their ego is an attestation of this reality. Thanks to this we have been reluctant to challenge the narrative that we are fed with as solutions to the problem, even though the results have been nothing to write home about. We have preferred to play ostrich than to challenge the narrative and proffer other ideas as opportunities. In our view to do that may seem confrontational or outright disrespectful. This behaviour in itself is not surprising, our tendency to want to preserve the status quo is well documented.

Whilst researching I came across the story of Korean Airlines and how they turned a poor safety record and high accident rate that nearly collapsed the company around to become one of the safest airlines to fly on today. Korea is even more power distant than Ghana but at the height of this crisis, they accepted that not challenging opinion especially amongst flight crew was one of the major reasons why their planes were crashing. It became apparent that most air crashes actually happened when the pilot was at the helm of the flight. A good listen to all the black box recordings indicated that none would challenge him even if they knew his choices were counterproductive as that depicted a lack of respect. They thus set out to re-educate their crew and to cut power distance out of their practice, it worked.

My belief is that we should have the same approach and challenge the use of just enforcement and regulation. This is why I advocate we confront the lawlessness of drug peddling through the enhancement of healthcare access. Whilst not advocating a shunting of all aspects of our social structure, we cannot ignore the obvious failings especially when a section of our youth are being turned into addicts through no fault of theirs. As a result, I propose that we should begin to concentrate on mass medicines education in an effort to complement enforcement and regulation as a matter of urgency. This education must be sustained and aggressive. It should be modelled on the 10,000-hour theory and have a long-term agenda. We need to educate till we get a critical mass of Ghanaians and approach the tipping point, the point where education leads to ideas and social trends that make us cease the initiative with unsalable momentum. It must target the population at large and be geared at untangling the misconception that drug peddling has any value. This education must be in languages that local communities are comfortable with as well as English. It should mimic the approach that the peddlers use but not sensationalise outcomes. We must not be oblivious that funds for such a venture will be hard to find. In undertaking this education we need to be aware that having allowed this problem to fester for decades, we are underdogs.

This in itself should not bother us. What should be of concern is that for over six decades we as a nation and especially health professionals have failed to think out of the box and take the fight to those who are breaking the law. Will any of us be able to look our image in the mirror and say the reasons why we have failed thus far is beyond our ability to undertake strategic thinking? I for one find it upsetting that with all the education and exposure, we have allowed ourselves to be outfoxed by people with absolutely no knowledge or specialty in the area of health. Yes, Gladwell is right when he opines that “We have, as human beings, a storytelling problem. We're a bit too quick to come up with explanations for things we don't really have an explanation for.”

The excuse we give for the current situation are not explanations for why we have thus far failed. The failure to deal with this menace has been because we have never taken the problem seriously and have lacked the understanding to realise that the only way to beat drug peddlers and quack doctors in this game is through sustained education. That's the only thing that will alter the market forces and change the face of the demand curve. Without a demand, the suppliers will be out of business.

 

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