Last week, The Sunday Times of Malta published a powerful human story revealing the real meaning of having medicines out of stock (‘Dad’s cancer drug agony’). The story did not deal with financial hardships, even if the medicine is very expensive, because it was simply not available to be purchased.
This particular shortage did not lead to mild but to serious inconvenience and degradation of the patient’s quality of life. This dire shortage of medicine resulted in excruciating pain for the patient.
The story’s introduction grips you:
“Attempting to get out of bed is a daily struggle for a cancer patient who needs a drug that has been out of stock for nearly three weeks. The 59-year-old man is in pain after being forced to skip his latest treatment of zoledronic acid, which is usually given along with chemotherapy to treat bone damage caused by his prostate cancer.”
The son of the man in question elaborates on the pain suffered by his father:
“His aching bones mostly affect his sternum and pelvis – he describes the pain as if somebody is sitting on his chest, and sometimes he says he feels as if somebody has given him a good walloping with a metal pipe.”
This is not the story of just one man – although even that would have been bad enough. We were informed that another 188 patients urgently need this medicine and are suffering similar agony.
This is not a solitary occurrence. For many years, far too many years, countless people have suffered unnecessarily, nay capriciously, because the medicine they needed was out of stock.
My assertion is based on experience. For the past few years, I have shared the anxiety of someone dear to me suffering for the many near misses and close shaves experienced when there was the peril that the medicine she badly needed could be out of stock. Somehow, in her case, unnecessary suffering was put on hold (until the next time) as the medicine fortunately always arrived on time in the end.
The attitude of the authorities described in the article brings back a deluge of bad memories. The journalist informed us that: “Unfortunately, the supplier was late in delivering the drug despite being repeatedly urged to speed up the process.” Read again: the action taken was simply that of repeatedly urging the supplier.
Another incident was when the auto-inject device of a particular medicine used by people with disability was out of stock. This meant that on top of the inconvenience of their condition and the painful side effects of the medicine, these people with disability had to go to some health centre late in the evening to be injected as that was the time when the medicine was administered.
I phoned the relevant section of the Health Department to complain about the situation. The reply of the civil servant was: “Miskin (poor thing) the agent has been trying for weeks to procure the self-inject device.”
I was gobsmacked.
“The msieken (victims) are the disabled people who are suffering, not the agent who is becoming rich in spite of his inefficiency,” I retorted angrily.
I then contacted some people in the media who in turn contacted the agent. The problem was solved in two days! The civil servants could have surely exerted more pressure had they threatened the agent with the cancellation of his contract.
When medicines are out of stock, politicians are held to account. This is right and fitting but insufficient.
Civil servants who are responsible for the management of the system should also be held accountable. The buck may stop with the politicians but it starts and should stay for most of the way with the civil servants.
Describing an inefficient agent as “miskin” or just “repeatedly urging him” is just not enough. The system needs to build in a proviso where his contract should be rescinded.
The civil servants are also responsible for effectively keeping an audit trail. This is not always done. I remember an incident, three years ago, when a person with disability was given medicine for just five days as, she was told, “stocks were very low”. When the person strongly complained with someone in a higher level of authority it transpired that there were stocks for a few more months.
It is also unacceptable that people’s medicines are changed without them being given a satisfactory explanation for the reason why this is happening. Then, to add insult to injury, in one particular case I know of, after only three months using the new medicine, patients were asked to start again the original medicine as considerable stocks were found!
Civil servants, even more than politicians, should be asked to answer for this inefficiency which capriciously causes a lot of suffering.
The buck may stop with the politicians but it starts and should stay for most of the way with the civil servants
Civil servants are also responsible to curb abuse. I know of another case where the person collecting medicines told the attendant that he did not need all the medicines on his card, while the attendant insisted that he takes them all.
Stories of people hoarding medicines are commonplace. And stories of people taking medicines for use by animals have also been reported.
Members of the medical profession provide a backdrop to the many people who abuse the system; scratch the surface and there is probably a doctor who is not doing his or her duty well enough.
Such abusers are not only stealing our tax money, they are also probably harming other patients. Abuses in the system siphon government money away from people who really need the medicine. There is less money for those who are in real need of help.
Since we are on the subject of medicines let me give vent to a pet subject of mine.
Free medicines are given to many, even to those who can easily afford them and who would not suffer any inconvenience if they buy them. This happens because several medicines are available free of charge without any means testing.
Free medicines should be available only to those who cannot afford them. The money saved should then go towards the financing of expensive medicines or toward inexpensive medicines which, in particular cases, cannot be afforded by some people.
Government monies should be spent only on those who need this help.
joseph.borg@um.edu.mt